From the Guidelines
A potassium level of 7.5 mEq/L represents severe hyperkalemia requiring immediate medical attention, and the patient should go to the emergency room right away as this is life-threatening. The treatment for severe hyperkalemia typically includes calcium gluconate IV to stabilize the heart, insulin with glucose to shift potassium into cells, sodium bicarbonate if acidotic, and possibly sodium polystyrene sulfonate (Kayexalate) or patiromer to remove potassium from the body 1. Dialysis may be necessary in severe cases. While awaiting emergency care, the patient should avoid high-potassium foods and medications that raise potassium levels such as ACE inhibitors, ARBs, potassium-sparing diuretics, and potassium supplements.
The condition is dangerous because elevated potassium disrupts normal electrical activity in the heart, potentially causing dangerous arrhythmias including ventricular fibrillation and cardiac arrest. Common causes of hyperkalemia include kidney failure, medication side effects, massive tissue breakdown, and adrenal insufficiency. After emergency treatment, the patient should follow-up with their doctor to identify and address the underlying cause. According to the European Heart Journal, hyperkalemia can be classified as mild, moderate, or severe, and the risk of arrhythmic emergencies and sudden arrhythmic death varies widely among patients 1.
Some key points to consider in the management of hyperkalemia include:
- The use of renin-angiotensin-aldosterone system inhibitors (RAASis) can increase the risk of hyperkalemia, especially in patients with chronic kidney disease or heart failure 1
- The implementation of mineralocorticoid receptor antagonists (MRAs) can help reduce the risk of hyperkalemia in patients with hypertension or heart failure 1
- The treatment of hyperkalemia should be individualized based on the severity of the condition, the presence of symptoms, and the underlying cause 1
- The patient should be closely monitored for signs of cardiac arrhythmias and other complications of hyperkalemia, and emergency medical attention should be sought if symptoms worsen or if the patient experiences any signs of cardiac distress.
From the Research
Hyperkalemia Diagnosis and Treatment
- A potassium level of 7.5 is considered hyperkalemia, a common electrolyte disorder that can result in morbidity and mortality if not managed appropriately 2.
- Hyperkalemia can be detected via serum clinical laboratory measurement, and its most severe effect includes various cardiac dysrhythmias, which may result in cardiac arrest and death 2.
Treatment Options
- Treatment for hyperkalemia includes measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion 2.
- Calcium gluconate 10% dosed 10 mL intravenously should be provided for membrane stabilization, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 2.
- Insulin and dextrose are frequently used to manage patients with hyperkalemia, but hypoglycemia after insulin use is a frequent complication during hyperkalemia management 3.
- Dialysis is the most efficient means to enable removal of excess potassium, and loop and thiazide diuretics can also be useful 2.
Management and Prevention
- Renal failure is a predisposing factor in three-quarters of cases of hyperkalemia, and drugs contribute to the development of hyperkalemia in half of the cases 4.
- Potassium intake, bioavailability, and hypertension are related, and increased potassium supplementation can decrease hypertension 5.
- Understanding potassium bioavailability from various sources may help to reveal how specific compounds and tissues influence potassium movement, and further the understanding of its role in health 5.