From the Guidelines
A potassium level of 5.7 mEq/L is mildly elevated and generally requires treatment to prevent cardiac arrhythmias and muscle weakness. According to the most recent and highest quality study 1, treatment options for hyperkalemia include intravenous calcium, insulin, and beta-agonists to redistribute potassium, as well as diuretics and potassium binders to increase potassium excretion.
Treatment Options
- Oral sodium polystyrene sulfonate (Kayexalate) 15-30g or patiromer (Veltassa) 8.4g once daily can be administered to lower potassium levels.
- Consider giving 10 units of regular insulin with 25g of glucose (D50W) intravenously for more rapid lowering if the patient is symptomatic.
- Loop diuretics like furosemide 20-40mg can also help excrete potassium if the patient isn't volume depleted.
Importance of Treatment
The severity of symptoms correlates with both the absolute potassium level and how quickly it rose. Hyperkalemia can lead to cardiac arrhythmias and muscle weakness, and treatment is important to prevent these complications.
Monitoring and Investigation
After initiating treatment, recheck potassium levels within 2-4 hours if severely elevated or within 24 hours if mildly elevated. Also, investigate the underlying cause, which could include medication effects (ACE inhibitors, ARBs, potassium-sparing diuretics), renal dysfunction, or excessive potassium intake, as noted in 1 and 1.
From the Research
Hyperkalemia Treatment
- Hyperkalemia is defined as a serum potassium level greater than 5.5 mmol/l 2
- A potassium level of 5.7 is considered hyperkalemia and requires treatment
- Treatment options include:
- Membrane stabilization with calcium gluconate 10% dosed 10 mL intravenously 3
- Shifting potassium from extracellular to intracellular stores with beta-agonists and intravenous insulin 3, 4
- Promoting potassium excretion with dialysis, loop and thiazide diuretics, and gastrointestinal elimination drugs 3, 5
- Urgent management is warranted for patients with potassium levels of 6.5 mEq/L or greater, or if ECG manifestations of hyperkalemia are present regardless of potassium levels, or if severe muscle symptoms occur 5
Treatment Considerations
- The choice of treatment depends on the severity of hyperkalemia and the presence of symptoms or ECG changes
- Patients with less severe hyperkalemia may be treated with renal elimination drugs or gastrointestinal elimination drugs 5
- Insulin and glucose are frequently used to manage patients with hyperkalemia, but hypoglycemia is a frequent complication and patients should be monitored for hypoglycemia hourly for at least 4-6 hours after administration 4
- New medications such as patiromer and sodium zirconium cyclosilicate hold promise for promoting gastrointestinal potassium excretion 3, 2