From the Guidelines
Hyperkalemia treatment should prioritize immediate stabilization of cardiac membranes with calcium gluconate 10% 10-30mL IV over 2-5 minutes, followed by measures to shift potassium intracellularly and promote its elimination from the body, as outlined in the most recent guidelines 1.
Treatment Approach
The management of hyperkalemia involves a stepwise approach based on the severity of hyperkalemia and the presence of symptoms. For severe hyperkalemia (K+ ≥7.0 mEq/L) or any hyperkalemia with ECG changes, immediate treatment is required.
- Stabilize cardiac membranes with calcium gluconate 10% 10-30mL IV over 2-5 minutes to counteract the cardiac effects of hyperkalemia, as recommended by recent clinical guidelines 1.
- Shift potassium into cells using insulin 10 units IV with 50mL of 50% dextrose and nebulized albuterol 10-20mg, which temporarily drives potassium into cells but does not reduce total body potassium 1.
- Promote potassium elimination from the body through the use of loop diuretics like furosemide 40-80mg IV if the patient has adequate renal function, and consider hemodialysis for refractory cases or severe renal failure 1.
Considerations for Renin-Angiotensin-Aldosterone System Inhibitors (RAASi)
In patients treated with RAASi, who are at risk of developing hyperkalemia, the use of potassium-binding agents such as patiromer 8.4g once daily or sodium polystyrene sulfonate (Kayexalate) 15-30g in sorbitol can help manage hyperkalemia and allow for the continuation of RAASi therapy, which is crucial for reducing mortality and morbidity in patients with cardiovascular disease 1.
Monitoring and Adjustments
Continuous cardiac monitoring is essential during the treatment of moderate to severe hyperkalemia. Potassium levels should be closely monitored, not only to follow the potassium-lowering effect but also to protect against the development of hypokalaemia, which can be more dangerous than hyperkalemia 1. Adjustments to treatment should be made based on the patient's clinical status, potassium levels, and renal function.
From the FDA Drug Label
CLINICAL STUDIES Medical literature also refers to the administration of calcium chloride in the treatment of magnesium intoxication due to overdosage of magnesium sulfate, and to combat the deleterious effects of hyperkalemia as measured by electrocardiogram (ECG), pending correction of the increased potassium level in the extracellular fluid.
The protocol for treating Hyperkalemia involves administering calcium chloride (IV) to combat its deleterious effects, as measured by electrocardiogram (ECG), pending correction of the increased potassium level in the extracellular fluid 2.
- The treatment is aimed at mitigating the effects of hyperkalemia.
- Calcium chloride (IV) is used in this context.
From the Research
Treatment Protocol for Hyperkalemia
The treatment protocol for hyperkalemia involves several steps, including:
- Elimination of reversible causes (diet, medications) 3
- Rapidly acting therapies that shift potassium into cells and block the cardiac membrane effects of hyperkalemia 3, 4, 5, 6
- Measures to facilitate removal of potassium from the body (saline diuresis, oral binding resins, and hemodialysis) 3, 5, 6, 7
Urgent Treatment Indications
Urgent treatment is indicated in cases of:
- Severe or symptomatic hyperkalemia 4
- Abrupt changes in potassium levels 4
- Electrocardiography changes 3, 4, 5, 6
- Presence of certain comorbid conditions 4
Treatment Options
Treatment options for hyperkalemia include:
- Calcium gluconate to stabilize cardiomyocyte membranes 3, 5, 6, 7
- Insulin injection to lower serum potassium levels 3, 4, 5, 6
- Beta-2 agonists (albuterol) to augment the effects of insulin and glucose 3, 5, 6, 7
- Hemodialysis to remove potassium from the body 3, 5, 6, 7
- Oral binding resins (sodium polystyrene sulfonate) for subacute treatment 4
Long-term Management
Long-term management of hyperkalemia involves: