From the Guidelines
Hyperkalemia treatment involves immediate intervention to lower potassium levels and prevent cardiac complications, with the most recent and highest quality study 1 guiding treatment decisions. For mild hyperkalemia (5.5-6.0 mEq/L), dietary potassium restriction and discontinuation of potassium-sparing medications may be sufficient.
- Key considerations for treatment include:
- Membrane stabilization with IV calcium gluconate (1-2 ampules of 10% solution over 2-3 minutes) to rapidly reduce the membrane excitatory effects of K+ on cardiac tissue
- Shifting potassium intracellularly with insulin (10 units regular insulin IV with 25g glucose) and albuterol nebulization (10-20 mg) to promote redistribution of serum K+ into the intracellular space
- Elimination therapies, such as sodium polystyrene sulfonate (15-30g orally or rectally), patiromer (8.4-16.8g daily), or sodium zirconium cyclosilicate (10g three times daily initially, then 5-10g daily), to increase K+ elimination from the body
- Loop diuretics like furosemide (40-80mg IV) to increase renal potassium excretion in patients with adequate kidney function
- Hemodialysis reserved for severe, refractory cases or in patients with kidney failure These treatments work through different mechanisms: calcium counteracts cardiac membrane excitability, insulin drives potassium into cells, exchange resins bind potassium in the gut, and diuretics enhance renal excretion. Continuous cardiac monitoring is essential during treatment, and addressing the underlying cause of hyperkalemia is crucial for preventing recurrence, as highlighted in the most recent study 1.
From the FDA Drug Label
Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia (1). 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 (1).
The treatment for hyperkalemia (elevated potassium levels) is Sodium Polystyrene Sulfonate Powder, for Suspension 2. However, it should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action.
From the Research
Treatment for Hyperkalemia
The treatment for hyperkalemia involves several steps, including:
- Elimination of reversible causes, such as diet and medications 3
- Rapidly acting therapies to shift potassium into cells and block the cardiac membrane effects of hyperkalemia, such as calcium gluconate, insulin, and beta-2 agonists 3, 4, 5, 6, 7
- Measures to facilitate removal of potassium from the body, such as saline diuresis, oral binding resins, and hemodialysis 3, 4, 7
Emergency Treatment
In cases of severe hyperkalemia (potassium level > 6.5 mEq/L or EKG changes), treatment should be started with:
- Calcium gluconate to stabilize cardiomyocyte membranes 3, 5, 6, 7
- Insulin injection, usually with concomitant glucose, to lower serum potassium levels 3, 4, 5, 6, 7
- Beta-2 agonists administration to augment the effects of insulin and glucose 3, 5, 6, 7
Long-term Management
Long-term management of hyperkalemia involves:
- Identifying and treating the underlying cause of hyperkalemia, such as kidney disease or medication use 4, 5, 6, 7
- Implementing measures to prevent recurrence or worsening of hyperkalemia, such as dietary changes and careful review of prescribed medications 3, 4, 5, 6, 7
- Consideration of medications that can aid in the reduction of serum potassium levels, such as sodium polystyrene sulfonate, sodium zirconium cyclosilicate, and patiromer 4