From the Guidelines
To manage hyperkalemia, the most effective approach is to stabilize myocardial cell membranes with calcium chloride or calcium gluconate, shift potassium into cells using sodium bicarbonate, and promote potassium excretion through diuresis with furosemide or potassium binders like sodium polystyrene sulfonate (Kayexalate) or patiromer (Veltassa), as recommended by the most recent guidelines 1.
Immediate Interventions
- Stabilize myocardial cell membrane with calcium chloride (10%): 5 to 10 mL (500 to 1000 mg) IV over 2 to 5 minutes or calcium gluconate (10%): 15 to 30 mL IV over 2 to 5 minutes, as outlined in the 2010 American Heart Association guidelines 1.
- Shift potassium into cells using sodium bicarbonate: 50 mEq IV over 5 minutes, as recommended in the same guidelines 1.
Promoting Potassium Excretion
- Diuresis with furosemide: 40 to 80 mg IV, as suggested in the 2010 American Heart Association guidelines 1.
- Potassium binders such as sodium polystyrene sulfonate (Kayexalate): 15 to 50 g plus sorbitol per oral or per rectum, or patiromer (Veltassa) 8.4g once daily, as mentioned in the expert consensus document on the management of hyperkalaemia 1.
Long-term Management
- Increase fluid intake to 2-3 liters daily unless contraindicated.
- Follow a low-potassium diet by avoiding foods like bananas, oranges, potatoes, tomatoes, and leafy greens.
- Regular monitoring of potassium levels is essential during treatment, and addressing the underlying cause of hyperkalemia is crucial for long-term management, as emphasized in the European Heart Journal 1.
Severe Cases
- In severe cases or if symptoms like muscle weakness or abnormal heart rhythms are present, immediate medical attention is necessary, and treatments like intravenous calcium gluconate, insulin with glucose, or albuterol nebulization may be required, as indicated in the expert consensus document on the management of hyperkalaemia 1.
From the Research
Management of Hyperkalemia
To manage hyperkalemia, several strategies can be employed, including:
- Stabilization of cardiac membranes using calcium gluconate 10% dosed 10 mL intravenously, as indicated by 2
- Shifting potassium from extracellular to intracellular stores using beta-agonists, such as salbutamol, and intravenous insulin, as suggested by 3, 2, and 4
- Promoting potassium excretion using loop and thiazide diuretics, as mentioned by 2
- Using new medications, such as patiromer and sodium zirconium cyclosilicate, to promote gastrointestinal potassium excretion, as discussed by 2 and 5
Treatment Options
The following treatment options are available for managing hyperkalemia:
- Glucose and insulin therapy, as mentioned by 3, 2, and 5
- Bicarbonate therapy, as discussed by 5 and 6
- Beta-2 agonists, such as salbutamol, as suggested by 4 and 6
- Dialysis, as mentioned by 2 and 5
- Potassium binding resins, such as sodium polystyrene sulfonate, as discussed by 3 and 5
Pharmacological Interventions
Pharmacological interventions for the acute management of hyperkalemia include:
- Salbutamol, which has been shown to be effective in reducing serum potassium levels, as indicated by 4 and 6
- Insulin-dextrose, which has been found to be effective in reducing serum potassium levels, as mentioned by 6
- Sodium bicarbonate, which has been studied as a potential treatment for hyperkalemia, as discussed by 6
- Aminophylline, which has been investigated as a potential treatment for hyperkalemia, as mentioned by 6