From the Guidelines
If your potassium level is 6.8 mmol/L, this is considered severe hyperkalemia and requires immediate medical attention, so you should go to the emergency room right away as this is potentially life-threatening. While waiting for emergency care, avoid foods high in potassium and stop any medications that might increase potassium levels (like certain blood pressure medications, potassium supplements, or NSAIDs) if you know them.
Treatment Options
In the hospital, treatment typically includes:
- Calcium gluconate to protect the heart, as it rapidly reduces the membrane excitatory effects of K+ on cardiac tissue within 1 to 3 minutes, thereby minimizing the potential for cardiac arrhythmia 1
- Insulin with glucose to drive potassium into cells, which acts within 30 minutes to promote redistribution of serum K+ into the intracellular space but does not change total body K+ levels 1
- Sodium bicarbonate if acidosis is present, which may be used to promote K+ excretion in patients with concurrent metabolic acidosis 1
- Possibly diuretics like furosemide, which can be used to manage hyperkalemia by increasing potassium excretion 1 In severe cases, dialysis may be necessary to increase K+ elimination from the body 1. Hyperkalemia at this level can cause dangerous heart rhythm abnormalities because potassium plays a crucial role in electrical conduction of the heart. Never attempt to treat severe hyperkalemia at home as it requires careful monitoring and medical intervention.
Key Considerations
It's essential to follow the most recent and highest quality guidelines for managing hyperkalemia, which emphasize the importance of prompt treatment and careful monitoring 1. The choice of treatment should be individualized based on the patient's specific condition, including the presence of acidosis, kidney function, and other factors that may influence potassium levels 1.
From the Research
Hyperkalemia Management
If potassium levels are 6.8 mEq/L, it is considered hyperkalemia, a condition that can lead to cardiac arrhythmias and muscle symptoms.
- 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 2.
- Treatment includes measures to stabilize cardiac membranes, to shift potassium from extracellular to intracellular stores, and to promote potassium excretion 3.
Treatment Options
- 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 3.
- Beta-agonists and intravenous insulin should be given, and some experts recommend the use of synthetic short-acting insulins rather than regular insulin 3.
- Dextrose should also be administered, as indicated by initial and serial serum glucose measurements 3.
- Dialysis is the most efficient means to enable removal of excess potassium 3.
- Loop and thiazide diuretics can also be useful 3.
- Sodium polystyrene sulfonate is not efficacious 3.
- New medications to promote gastrointestinal potassium excretion, which include patiromer and sodium zirconium cyclosilicate, hold promise 3, 4.
Monitoring and Prevention
- Patients receiving insulin for hyperkalemia should be monitored for hypoglycemia hourly for at least 4-6 hours after administration 5.
- The risk of hyperkalemia increases as renal function declines, and starting treatment early when eGFR is maintained can reduce side effects 6.
- The simultaneous use of RAS inhibitors, finerenone, and SGLT2 inhibitors appears to be a promising treatment, and it is important to continue the medications of RAS inhibitors and MR antagonists as long as possible 6.
- A new oral potassium adsorbent can be used to prevent hyperkalemia and allow for the continuation of RAS inhibitors or MR antagonists 6.