How to reduce hyperkalemia (elevated potassium levels)?

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Last updated: April 11, 2025 • View editorial policy

From the Guidelines

To reduce potassium levels, it is essential to limit intake of high-potassium foods, use loop diuretics like furosemide, and consider potassium binders like sodium polystyrene sulfonate, as these approaches can help reduce morbidity and mortality associated with hyperkalemia. According to the most recent and highest quality study 1, management of acute hyperkalemia depends on the magnitude or severity of the increase in K+ concentration, especially when combined with marked electrocardiographic (ECG) changes and severe muscle weakness. Some key points to consider:

  • Limiting intake of high-potassium foods such as bananas, oranges, potatoes, tomatoes, beans, and leafy greens, and choosing low-potassium alternatives like apples, berries, rice, and pasta can help reduce potassium levels 2, 3.
  • Cooking methods like soaking vegetables in water for several hours before cooking can help reduce potassium content 3.
  • Staying well-hydrated with water, unless there are fluid restrictions, is also important.
  • For medications, loop diuretics like furosemide (20-80mg daily) can help excrete potassium through urine, and sodium polystyrene sulfonate (Kayexalate, 15g 1-4 times daily) binds potassium in the intestines for removal 4, 1, 5.
  • In emergency situations with dangerously high levels, insulin with glucose may be administered intravenously to drive potassium into cells temporarily, and regular monitoring of potassium levels is essential, especially if there is kidney disease, certain medications are being taken, or there are conditions that affect potassium balance 1, 5. It is crucial to note that the treatment options for acute and chronic hyperkalemia include intravenous calcium, insulin, beta-agonists, sodium bicarbonate, and hemodialysis, and the choice of treatment depends on the severity of the condition and the presence of other underlying health issues 1, 5.

From the FDA Drug Label

Sodium Polystyrene Sulfonate Powder, for Suspension increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract Binding of potassium reduces the concentration of free potassium in the gastrointestinal lumen, resulting in a reduction of serum potassium levels. The practical exchange ratio is 1 mEq K per 1 gram of resin. To reduce potassium, Sodium Polystyrene Sulfonate Powder, for Suspension can be used as it binds to potassium in the gastrointestinal tract and increases its excretion, thereby reducing serum potassium levels 6.

  • The exchange ratio is 1 mEq K per 1 gram of resin.
  • The effective lowering of serum potassium may take hours to days.

From the Research

Methods to Reduce Potassium

  • Calcium polystyrene sulfonate can rapidly reduce potassium levels in patients with stage 3-5 non-dialysis chronic kidney disease without adverse effects on sodium, phosphorus, or calcium levels 7
  • Sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) can be used to treat hyperkalemia, but SPS may decrease serum calcium and magnesium and increase intact parathyroid hormone (iPTH) values, whereas CPS reduces iPTH 8
  • Sodium zirconium cyclosilicate (SZC) and SPS have similar rates of normokalemia achievement with IV insulin for the treatment of acute hyperkalemia 9
  • Potassium binders, such as patiromer and sodium zirconium cyclosilicate, may cause fewer gastrointestinal side-effects compared to older agents like sodium polystyrene sulfonate and calcium polystyrene sulfonate 10

Comparison of Potassium-Lowering Agents

  • Calcium polystyrene sulfonate and sodium polystyrene sulfonate have different effects on mineral and bone metabolism, with CPS being safer for the treatment of hyperkalemia in pre-dialysis patients 8
  • Sodium zirconium cyclosilicate and sodium polystyrene sulfonate have similar efficacy in reducing potassium levels, but SZC may have a more favorable safety profile 9
  • Patiromer and sodium zirconium cyclosilicate are newer ion exchange resins that may cause fewer gastrointestinal side-effects compared to older agents 10

Pharmacology and Dosing

  • Potassium-lowering agents, such as sodium polystyrene sulfonate, patiromer, and sodium zirconium cyclosilicate, differ in their pharmacology and mechanism of action, clinical efficacy, and potential safety and adverse effect profiles 11
  • The dosage and administration of these agents vary, and the choice of agent depends on the individual patient's needs and medical history 11

References

Guideline

clinical management of hyperkalemia.

Mayo Clinic Proceedings, 2021

Guideline

clinical management of hyperkalemia.

Mayo Clinic Proceedings, 2021

Research

Potassium binders for chronic hyperkalaemia in people with chronic kidney disease.

The Cochrane database of systematic reviews, 2020

Research

Potassium-lowering agents for the treatment of nonemergent hyperkalemia: pharmacology, dosing and comparative efficacy.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2019

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.