What are the medications for hyperkalemia (elevated potassium levels) in a hospital setting?

From the Guidelines

For hyperkalemia in the hospital setting, the most effective treatment approach is to use a combination of medications that stabilize cardiac membranes, shift potassium into cells, and remove excess potassium from the body, as recommended by the most recent and highest quality study 1.

Treatment Approach

The treatment of hyperkalemia depends on the severity and urgency of the condition. For acute severe hyperkalemia (potassium >6.5 mmol/L or with ECG changes), the following medications can be used:

• IV calcium gluconate 10% (10 mL over 2-3 minutes) to stabilize cardiac membranes
• IV insulin (10 units regular insulin) with glucose (25-50g of D50W) to shift potassium intracellularly
• Nebulized albuterol 10-20 mg to shift potassium into cells

Ongoing Management

For ongoing management, the following medications can be used:

• Sodium polystyrene sulfonate (Kayexalate) 15-30g orally or rectally
• Newer potassium binders like patiromer (Veltassa) 8.4-25.2g daily or sodium zirconium cyclosilicate (Lokelma) 10g TID
• Loop diuretics like furosemide 40-80mg IV, if the patient has adequate renal function These medications work through different mechanisms: calcium stabilizes cardiac membranes without affecting potassium levels, insulin/glucose and albuterol drive potassium into cells, while binders and diuretics remove potassium from the body.

Key Considerations

It is essential to address the underlying cause of hyperkalemia and monitor potassium levels, renal function, and cardiac status during treatment, as recommended by 1 and 1. Additionally, the use of renin-angiotensin-aldosterone system inhibitors (RAASi) should be carefully monitored, as they can increase the risk of hyperkalemia, especially in patients with cardiovascular disease and chronic kidney disease 1.

From the FDA Drug Label

The total exposure to LOKELMA in the safety and efficacy clinical trials of patients not on dialysis with hyperkalemia was 1,760 patients

• Sodium zirconium cyclosilicate (LOKELMA) is a medication used to treat hyperkalemia in a hospital setting, as evidenced by its use in clinical trials for patients with hyperkalemia 2.
• The medication is administered orally (PO) and has been shown to be effective in reducing serum potassium levels in patients with hyperkalemia.
• Key considerations for the use of sodium zirconium cyclosilicate in a hospital setting include monitoring for adverse reactions such as edema and constipation, as well as laboratory abnormalities like hypokalemia.

From the Research

Medications for Hyperkalemia in a Hospital Setting

The following medications are used to treat hyperkalemia in a hospital setting:

• Glucose and insulin: used to shift potassium into cells 3, 4, 5, 6, 7
• Calcium gluconate: used to stabilize cardiomyocyte membranes and prevent cardiac arrhythmias 3, 4, 5, 6, 7
• Beta-2 agonists: used to shift potassium into cells and prevent cardiac arrhythmias 3, 4, 5, 6, 7
• Sodium bicarbonate: used to correct acidosis and shift potassium into cells 4, 5, 6, 7
• Sodium polystyrene sulfonate (SPS): a potassium-binding resin used to remove potassium from the body 3, 5, 7
• Sodium zirconium cyclosilicate (SZC): a potassium-binding resin used to remove potassium from the body 3, 5, 6, 7
• Patiromer: a potassium-binding resin used to remove potassium from the body 3, 5, 6, 7
• Dialysis: used to remove potassium from the body in severe cases of hyperkalemia 3, 4, 5, 6, 7

Treatment Strategies

Treatment strategies for hyperkalemia include:

• Eliminating reversible causes of hyperkalemia, such as dietary factors and medications 4, 5, 7
• Using rapidly acting therapies to shift potassium into cells and prevent cardiac arrhythmias 4, 5, 6, 7
• Using measures to facilitate removal of potassium from the body, such as saline diuresis, oral binding resins, and hemodialysis 4, 5, 6, 7