From the Guidelines
The treatment for a potassium level of 6.0 mEq/L (hyperkalemia) should prioritize immediate interventions to lower potassium levels and prevent cardiac complications, with first-line treatment including calcium gluconate 10% (10 mL IV over 2-3 minutes) to stabilize cardiac membranes, as recommended by the most recent guidelines 1.
Key Interventions
- Stabilize myocardial cell membrane with calcium chloride (10%): 5 to 10 mL (500 to 1000 mg) IV over 2 to 5 minutes or calcium gluconate (10%): 15 to 30 mL IV over 2 to 5 minutes, as outlined in the American Heart Association guidelines 1.
- Shift potassium into cells using sodium bicarbonate: 50 mEq IV over 5 minutes, especially in acidotic patients, as suggested by the American Heart Association guidelines 1.
Potassium Removal
- Loop diuretics like furosemide (40-80mg IV) can help increase potassium excretion in patients with adequate kidney function, as recommended by the American Heart Association guidelines 1.
- Sodium polystyrene sulfonate (Kayexalate, 15-30g orally or rectally) or newer potassium binders like patiromer (8.4g once daily) or sodium zirconium cyclosilicate (10g three times daily) can be used for potassium removal, as discussed in the Mayo Clinic Proceedings 1.
Additional Considerations
- Identify and address the underlying cause of hyperkalemia, such as medication effects, kidney dysfunction, or excessive potassium intake, and monitor potassium levels frequently during treatment, as emphasized by the European Society of Cardiology guidelines 1.
- Hemodialysis may be necessary for severe cases or when other measures fail, as noted in the American Heart Association guidelines 1.
From the FDA Drug Label
Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia (1) The average total daily adult dose of Sodium Polystyrene Sulfonate Powder, for Suspension is 15 g to 60 g, administered as a 15-g dose (four level teaspoons), one to four times daily (2.1)
The treatment for potassium 6.0 (hyperkalemia) is Sodium Polystyrene Sulfonate Powder, for Suspension, with a daily dose of 15 g to 60 g, administered orally as a 15-g dose, one to four times daily 2.
- The dose can also be administered rectally, with an average adult dose of 30 g to 50 g every six hours 2.
- However, it should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2 2.
From the Research
Treatment for Hyperkalemia
The treatment for hyperkalemia, particularly for a potassium level of 6.0, involves several steps:
- Urgent management: Intravenous calcium, intravenous insulin, and inhaled beta agonists are used to manage severe hyperkalemia 3.
- Membrane stabilization: Calcium gluconate 10% dosed 10 mL intravenously is provided for membrane stabilization, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 4.
- Cellular shift: Insulin, usually with concomitant glucose, and albuterol are preferred to lower serum potassium levels in the acute setting 5, 4.
- Excretion: Dialysis is the most efficient means to enable removal of excess potassium, and loop and thiazide diuretics can also be useful 4.
- New medications: Patiromer and sodium zirconium cyclosilicate, which promote gastrointestinal potassium excretion, hold promise for the treatment of hyperkalemia 4, 6, 7.
Considerations
- Electrocardiography: Electrocardiography changes, such as cardiac conduction disturbances, are an indication for urgent treatment 5, 3.
- Underlying causes: The underlying cause of hyperkalemia should be addressed, and potassium levels replenished 7.
- Long-term management: Long-term management of potassium disturbances includes correcting underlying conditions, dietary counseling, and adjusting causative medications 7.