From the Guidelines
The treatment of hyperkalemia should prioritize the use of potassium binders, such as patiromer sorbitex calcium (PSC) or sodium zirconium cyclosilicate (SZC), to enable patients to continue renin-angiotensin-aldosterone system inhibitors (RAASi) therapy, which reduces mortality and morbidity in patients with cardiovascular disease 1. The management of hyperkalemia involves a multifaceted approach, considering the severity and urgency of the condition. For mild to moderate hyperkalemia, restricting dietary potassium and discontinuing medications that can increase potassium levels, such as ACE inhibitors, ARBs, and potassium-sparing diuretics, is crucial.
- Key considerations include:
- Evaluating the patient's diet, use of supplements, salt substitutes, and nutraceuticals that contain potassium
- Assessing concomitant medications that may contribute to hyperkalemia
- Monitoring kidney function and potassium levels closely
- Treatment options for hyperkalemia include:
- Potassium binders, such as PSC or SZC, which increase fecal potassium excretion
- Loop diuretics, like furosemide, to enhance potassium excretion through the kidneys
- Sodium polystyrene sulfonate (Kayexalate) to remove potassium from the body through the gastrointestinal tract
- For severe hyperkalemia or when ECG changes are present, immediate interventions are necessary, including:
- Calcium gluconate to stabilize cardiac membranes
- Insulin with glucose to drive potassium into cells temporarily
- Albuterol to shift potassium intracellularly
- Sodium bicarbonate in acidotic patients
- Regular monitoring of potassium levels and cardiac status is essential during treatment, and the use of potassium-lowering agents should be maintained unless another etiology for hyperkalemia is identified 1.
From the FDA Drug Label
Sodium polystyrene sulfonate is a potassium binder indicated for the treatment of hyperkalemia Limitation of Use: Sodium polystyrene sulfonate should not be used an emergency treatment for life threatening hyperkalemia because of its delayed onset of action The average total daily adult dose of sodium polystyrene sulfonate is 15 g to 60 g, administered as a 15 g dose (four level teaspoons), one to four times daily The average adult dose is 30 g to 50 g every six hours
The treatment for hyperkalemia is sodium polystyrene sulfonate, a potassium binder, with a dose of:
- 15 g to 60 g per day, administered orally as 15 g (four level teaspoons) one to four times daily
- 30 g to 50 g every six hours, administered rectally 2 2
From the Research
Treatment Options for Hyperkalemia
The treatment for hyperkalemia includes various approaches to manage the condition, which can be life-threatening if not addressed promptly. The following are some of the treatment options:
- Elimination of reversible causes, such as dietary changes and medication adjustments 3
- Rapidly acting therapies to shift potassium into cells and block the cardiac membrane effects of hyperkalemia, including calcium gluconate, insulin, and beta-agonists 3, 4, 5
- Measures to facilitate removal of potassium from the body, such as saline diuresis, oral binding resins, and hemodialysis 3, 4, 5
Pharmacotherapies for Hyperkalemia
Several pharmacotherapies are available to manage hyperkalemia, including:
- Glucose and insulin to help shift potassium into cells 4
- Bicarbonate to help manage acid-base balance 4
- Calcium gluconate to stabilize cardiomyocyte membranes 3, 4, 5
- Beta-2 agonists to help shift potassium into cells 3, 4, 5
- Sodium polystyrene sulfonate (SPS), sodium zirconium cyclosilicate (SZC), and patiromer, which are oral binding resins that help remove potassium from the body 4, 6, 7
Role of New Potassium Binders
New potassium binders, such as patiromer and SZC, have been developed to manage hyperkalemia. These agents have demonstrated rapid and sustained reductions in serum potassium levels, coupled with favorable safety and tolerability profiles, in multiple clinical trials 6, 7. They offer significant advantages over traditional therapies, providing effective and better-tolerated options for patients 7.