From the Guidelines
Hyperkalemia is a life-threatening condition that requires immediate attention, and the most effective treatment approach involves a combination of calcium gluconate, insulin, and potassium binders, as well as addressing the underlying cause, as recommended by the most recent study 1.
Causes of Hyperkalemia
The causes of hyperkalemia can be divided into two main categories:
- Decreased potassium excretion, which can be caused by medications such as potassium-sparing diuretics, beta-blockers, NSAIDs, and renin-angiotensin-aldosterone inhibitors, as well as kidney disease or failure 1.
- Increased potassium intake or administration, which can be caused by potassium supplements, certain foods, or stored blood products 1.
Treatment of Hyperkalemia
The treatment of hyperkalemia depends on the severity of the condition and the presence of symptoms.
- For mild hyperkalemia, dietary potassium restriction and review of medications that may increase potassium levels are recommended.
- For moderate to severe hyperkalemia, immediate treatment is necessary, and may include:
- Calcium gluconate to stabilize cardiac membranes
- Insulin and glucose to shift potassium intracellularly
- Sodium bicarbonate to promote potassium excretion in acidotic patients
- Potassium binders, such as sodium polystyrene sulfonate, patiromer, or sodium zirconium cyclosilicate, to remove potassium from the body
- Loop diuretics, such as furosemide, to increase potassium excretion in patients with adequate kidney function
- Hemodialysis, which is the definitive treatment for severe or refractory hyperkalemia, especially in patients with kidney failure 1.
Prevention of Recurrence
After acute management, identifying and addressing the underlying cause of hyperkalemia is essential to prevent recurrence.
- This may involve adjusting medications, restricting dietary potassium intake, or treating underlying kidney disease or other conditions that may be contributing to hyperkalemia 1.
From the Research
Causes of Hyperkalemia
- Hyperkalemia is a life-threatening condition caused by extracellular potassium shift or decreased renal potassium excretion 2
- Certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others, can lead to hyperkalemia 3
- Acute kidney injury, critical illness, crush injuries, and massive red blood cell transfusions can result in hyperkalemia 4
- Diuretic use and gastrointestinal losses are not common causes of hyperkalemia, but rather of hypokalemia; however, kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia 5
Symptoms of Hyperkalemia
- Hyperkalemia usually presents with non-specific symptoms 2
- Many of the signs of hyperkalemia are nonspecific 3
- Characteristic electrocardiogram findings are associated with hyperkalemia along with laboratory potassium levels 3
- Severe hyperkalemia can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction 5
Treatments of Hyperkalemia
- Management of hyperkalemia includes the elimination of reversible causes (diet, medications), rapidly acting therapies that shift potassium into cells and block the cardiac membrane effects of hyperkalemia, and measures to facilitate removal of potassium from the body (saline diuresis, oral binding resins, and hemodialysis) 2
- Treatment should be started with calcium gluconate to stabilize cardiomyocyte membranes, followed by insulin injection, and b-agonists administration 2, 6
- Hemodialysis remains the most reliable method to remove potassium from the body and should be used in cases refractory to medical treatment 2
- New medications to promote gastrointestinal K+ excretion, which include patiromer and sodium zirconium cyclosilicate, hold promise 6, 3, 4
- Loop and thiazide diuretics can also be useful 6
- Sodium polystyrene sulfonate is not efficacious 6 or is reserved for subacute treatment 5