What is the treatment for hyperkalemia?

From the Guidelines

Treatment for hyperkalemia should be initiated immediately with a combination of calcium carbonate, insulin, and beta adrenoceptor agonists to stabilize the myocardial cell membrane and redistribute potassium to the intracellular space.

Treatment Options

• Cardiac membrane stabilization: Calcium chloride or gluconate (IV) can be used to stabilize the cardiac membrane within 1 to 3 minutes 1.
• Redistribute potassium: Insulin (IV) with or without glucose, and beta adrenoceptor agonists (e.g. salbutamol) can be used to redistribute potassium to the intracellular space, with effects lasting 30 to 60 minutes 1.
• Increase potassium elimination: Loop diuretics (IV or oral) can increase renal potassium excretion, while hemodialysis can remove potassium from the blood 1.
• Potassium binders: Newer potassium binders such as patiromer sorbitex calcium and sodium zirconium cyclosilicate can enhance fecal potassium excretion and may facilitate optimization of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy 1.

Important Considerations

• Monitoring: Serum potassium levels should be individualized, with increased frequency of monitoring considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia, and for those receiving RAASi therapy 1.
• Dietary restrictions: The need for stringent dietary potassium restrictions in patients receiving potassium-binder therapy requires further study 1.
• RAASi therapy: RAASi therapy should be started at a low dosage and titrated to the maximum tolerated evidence-based doses, with close monitoring of potassium levels 1.

From the Research

Treatment Options for Hyperkalemia

The treatment for hyperkalemia involves various approaches, including:

• Elimination of reversible causes (diet, medications) 2
• Rapidly acting therapies that shift potassium into cells and block the cardiac membrane effects of hyperkalemia 2, 3
• Measures to facilitate removal of potassium from the body, such as:
  • Saline diuresis 2
  • Oral binding resins 2, 3, 4
  • Hemodialysis 2, 3, 5
• Pharmacotherapies, including:
  • Calcium gluconate to stabilize cardiomyocyte membranes 2, 3, 5
  • Insulin injection to shift potassium into cells 2, 3, 5
  • Beta-2 agonists administration to shift potassium into cells 2, 3
  • Sodium polystyrene sulfonate (SPS), sodium zirconium cyclosilicate (SZC), and patiromer to reduce serum potassium levels 3, 4

Acute Management of Hyperkalemia

In cases of acute hyperkalemia, treatment should be started with:

• Calcium gluconate to stabilize cardiomyocyte membranes 2, 3, 5
• Insulin injection to shift potassium into cells 2, 3, 5
• Beta-2 agonists administration to shift potassium into cells 2, 3
• Hemodialysis may be necessary in severe cases or when medical treatment is ineffective 2, 3, 5

Chronic Management of Hyperkalemia

For chronic management of hyperkalemia, the goal is to stabilize serum potassium levels and prevent life-threatening arrhythmias 6. This can be achieved through:

• Dietary modifications to limit potassium intake
• Medications that help remove potassium from the body, such as oral binding resins 2, 3, 4
• Regular monitoring of potassium levels to adjust treatment as needed 5