From the Guidelines
To decrease high potassium (hyperkalemia), the most effective approach is to use a combination of emergency treatments, including calcium gluconate to protect the heart, insulin with glucose to drive potassium into cells, or dialysis, as recommended by the most recent study published in 2021 in the Mayo Clinic Proceedings 1.
Treatment Options
The treatment of hyperkalemia depends on the severity of the condition and the presence of electrocardiographic changes or muscle weakness. The following options are available:
- Intravenous calcium gluconate to rapidly reduce the membrane excitatory effects of potassium on cardiac tissue
- Insulin and glucose to promote redistribution of potassium into the intracellular space
- Inhaled β-agonists, such as salbutamol, to promote redistribution of potassium into the intracellular space
- Loop diuretics, such as furosemide, to increase potassium excretion through urine
- Hemodialysis to increase potassium elimination from the body
Dietary Changes
In addition to these treatments, dietary changes can help manage hyperkalemia. This includes:
- Limiting potassium-rich foods, such as bananas, oranges, potatoes, tomatoes, and leafy greens
- Increasing water intake to help the kidneys flush out excess potassium
- Avoiding salt substitutes, which often contain potassium
Medication Adjustments
If medications that raise potassium levels, such as ACE inhibitors, ARBs, or certain NSAIDs, are being taken, the doctor may need to adjust these medications to help manage hyperkalemia.
Importance of Monitoring
It is essential to monitor potassium levels regularly, especially in patients with kidney disease, to prevent hyperkalemia and its complications, as highlighted in the study published in 2018 in the European Heart Journal 1.
Recent Guidelines
The most recent guidelines, published in 2021, emphasize the importance of individualized treatment approaches for hyperkalemia, taking into account the underlying cause, severity, and patient-specific factors, such as kidney function and medication use 1.
From the Research
Treatment Options for Hyperkalemia
To decrease high potassium levels, several treatment options are available, including:
- Membrane stabilization using calcium gluconate 10% dosed 10 mL intravenously, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 2
- Shifting potassium from extracellular to intracellular stores using beta-agonists and intravenous insulin, with some experts recommending the use of synthetic short-acting insulins rather than regular insulin 2
- Promoting potassium excretion through dialysis, which is the most efficient means of removing excess potassium 2
- Using loop and thiazide diuretics to promote potassium excretion 2
- Administering glucose and insulin to help shift potassium into cells, with careful monitoring for hypoglycemia 3
Medications for Hyperkalemia
Several medications are available to help reduce serum potassium levels, including:
- Sodium zirconium cyclosilicate (SZC) and patiromer, which work primarily in the gastrointestinal tract to promote potassium excretion 4
- Sodium polystyrene sulfonate (SPS), although its efficacy has been questioned 2, 4
- New medications that hold promise for promoting gastrointestinal potassium excretion, such as patiromer and SZC 2
Management Considerations
When managing patients with hyperkalemia, it is essential to consider the following:
- The risk of hypoglycemia with insulin therapy, particularly in patients with low pretreatment glucose, no history of diabetes mellitus, female gender, abnormal renal function, and lower body weight 3
- The need for careful monitoring of serum glucose levels and potassium levels during treatment 3
- The importance of individualizing treatment based on the patient's specific needs and medical history 4, 5