What are the management strategies for Hyperkalemia (elevated potassium levels)?

From the Guidelines

Hyperkalemia management requires prompt intervention based on severity and symptoms, with the most recent and highest quality study suggesting that for moderate to severe hyperkalemia, treatment should start with IV calcium gluconate 10% (10 mL over 2-3 minutes) to stabilize cardiac membranes if ECG changes are present, followed by administration of insulin (10 units regular insulin IV) with glucose (25-50g IV) to shift potassium intracellularly, as recommended by the 2021 study in Mayo Clinic Proceedings 1. For mild hyperkalemia (K+ 5.5-6.0 mEq/L), dietary potassium restriction and discontinuation of potassium-sparing medications (ACE inhibitors, ARBs, NSAIDs) may be sufficient. The following key points should be considered in the management of hyperkalemia:

• Discontinuation of medications that may cause hyperkalemia, such as potassium-sparing diuretics, beta-blockers, and NSAIDs, as outlined in the 2018 expert consensus document 1.
• Use of IV calcium gluconate to stabilize cardiac membranes, as recommended by the 2021 study in Mayo Clinic Proceedings 1.
• Administration of insulin with glucose to shift potassium intracellularly, as suggested by the 2021 study in Mayo Clinic Proceedings 1.
• Use of nebulized albuterol to promote intracellular potassium shift, as recommended by the 2021 study in Mayo Clinic Proceedings 1.
• Use of potassium binders, such as sodium polystyrene sulfonate, patiromer, or sodium zirconium cyclosilicate, to remove potassium from the body, as suggested by the 2021 study in Mayo Clinic Proceedings 1.
• Use of loop diuretics, such as furosemide, to enhance renal potassium excretion in patients with adequate kidney function, as recommended by the 2021 study in Mayo Clinic Proceedings 1.
• Hemodialysis for severe or refractory hyperkalemia, as suggested by the 2021 study in Mayo Clinic Proceedings 1. It is essential to identify and address the underlying cause of hyperkalemia to prevent recurrence, as these interventions primarily provide temporary correction, as noted in the 2021 study in Mayo Clinic Proceedings 1. The management of hyperkalemia should be individualized, taking into account the patient's medical history, current medications, and kidney function, as recommended by the 2021 study in Mayo Clinic Proceedings 1. Continuous cardiac monitoring and serial potassium measurements are crucial to assess the response to treatment, as suggested by the 2021 study in Mayo Clinic Proceedings 1.

From the FDA Drug Label

The intensity and duration of therapy depend upon the severity and resistance of hyperkalemia. Oral The average total daily adult dose of Sodium Polystyrene Sulfonate Powder, for Suspension is 15 g to 60 g, administered as a 15-g dose (four level teaspoons), one to four times daily. Rectal The average adult dose is 30 g to 50 g every six hours.

The management strategies for Hyperkalemia (elevated potassium levels) include:

• Oral administration of Sodium Polystyrene Sulfonate Powder, for Suspension, with a dose of 15 g to 60 g per day, divided into 1 to 4 doses
• Rectal administration of Sodium Polystyrene Sulfonate Powder, for Suspension, with a dose of 30 g to 50 g every 6 hours
• Monitoring of serum potassium levels during therapy to avoid severe hypokalemia
• Monitoring of calcium and magnesium levels in patients receiving Sodium Polystyrene Sulfonate Powder, for Suspension, as it is not totally selective for potassium and may cause loss of other cations 2