From the Research
Replenishing Potassium in Hyperchloremia
- The approach to replenishing potassium (K+) in the context of hyperchloremia is crucial, as potassium homeostasis is maintained delicately and governed by daily consumption and renal excretion mechanisms 1.
- In cases of hypokalemia, intravenous repletion therapy with potassium chloride (KCl) can be used, and the addition of lidocaine can improve patient tolerance to intravenous KCl replacement 2.
- However, the use of potassium-enriched salt substitutes as a means to lower blood pressure and increase potassium intake should be approached with caution, as it may pose a risk of hyperkalemia, especially in people with conditions that impair potassium excretion such as chronic kidney disease 3.
- The treatment of hyperkalemia typically involves stabilizing the cardiac membrane, followed by maneuvers to shift K+ into the cells, and ultimately initiating strategies to decrease total body K+ content 4.
- In acute overdose situations due to ingestion of potassium salt, the general principles of treatment for overdoses should be followed, including the use of calcium chloride infusion, dextrose and insulin in water, and correction of acidosis with sodium bicarbonate 1, 5.
Key Considerations
- Potassium toxicity can manifest in significant, characteristic, acute cardiovascular changes with ECG abnormalities, as well as neuromuscular and gastrointestinal symptoms 1, 5.
- The severity and associated risk of hyperkalemia depend on the underlying cause and rate of potassium increase, and treatment should be tailored accordingly 4.
- Clinicians should be vigilant in monitoring potassium intake from over-the-counter supplements and should prescribe any potassium supplements carefully to their patients, monitoring plasma potassium periodically 1, 5.