From the Guidelines
Hyperkalemia treatment should prioritize immediate intervention with calcium gluconate, insulin, and glucose to stabilize cardiac membranes and shift potassium intracellularly, as evidenced by the most recent study in 2021 1.
Treatment Options
The treatment of hyperkalemia depends on the severity and symptoms of the condition. For mild hyperkalemia, dietary potassium restriction and discontinuation of potassium-sparing medications may be sufficient. However, for moderate to severe hyperkalemia or when ECG changes are present, immediate intervention is necessary.
Immediate Intervention
- Calcium gluconate 10% (10 mL IV over 2-3 minutes) should be administered first to stabilize cardiac membranes if ECG changes are present, as recommended by the 2021 study 1.
- Insulin (10 units regular insulin IV) with glucose (25-50g IV) should be administered to shift potassium intracellularly and prevent hypoglycemia.
- Albuterol nebulization (10-20 mg) can also promote intracellular potassium shift.
Potassium Removal
- Sodium polystyrene sulfonate (15-30g orally or rectally) can be used to remove potassium from the body, although it works slowly.
- Patiromer (8.4-25.2g daily) or sodium zirconium cyclosilicate (10g TID for 48 hours, then 10g daily) are newer potassium binders with fewer side effects.
- Loop diuretics like furosemide (40-80mg IV) can enhance renal potassium excretion in patients with adequate kidney function.
Long-term Management
- Addressing the underlying cause of hyperkalemia is essential for long-term management to prevent recurrence.
- The 2018 study 1 highlights the importance of monitoring potassium levels in patients treated with renin-angiotensin-aldosterone system inhibitors, particularly in high-risk patients.
Key Considerations
- The symptoms of hyperkalemia can be nonspecific, and ECG findings can be highly variable and not as sensitive as laboratory tests in predicting hyperkalemia or its associated complications 1.
- Hemodialysis provides rapid and effective potassium removal and may be used as an adjunctive therapy in acute hyperkalemia after instituting other approaches 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia.
Limitation of Use: Sodium Polystyrene Sulfonate Powder, for Suspension should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action [see Clinical Pharmacology (12.2)].
The treatment option for hyperkalemia (elevated potassium levels) is Sodium Polystyrene Sulfonate Powder, for Suspension. However, it is not recommended for emergency treatment of life-threatening hyperkalemia due to its delayed onset of action 2.
From the Research
Treatment Options for Hyperkalemia
The treatment options for hyperkalemia can be categorized into acute and chronic management strategies.
- Acute management includes:
- Administration of intravenous calcium salts to stabilize the resting cardiac membrane potential 3, 4, 5
- Intravenous insulin combined with an infusion of glucose to stimulate intracellular uptake of potassium 3, 4, 5
- Nebulized β-2 adrenoceptor agonists to augment the effects of intravenous insulin and glucose 3, 4, 5
- Hemodialysis to remove potassium from the body in severe cases 4
- Chronic management includes:
Medications for Hyperkalemia
Several medications are available to manage hyperkalemia, including:
- Sodium polystyrene sulfonate (SPS) 6
- Sodium zirconium cyclosilicate (SZC) 6
- Patiromer 6
- Insulin and glucose 3, 4, 5
- β-2 adrenoceptor agonists such as albuterol 3, 4, 5
- Calcium gluconate 3, 4, 5
Importance of Prompt Treatment
Prompt recognition and treatment of hyperkalemia are crucial to prevent life-threatening cardiac arrhythmias and muscle paralysis 3, 4, 5.