But hyperkalemia can affect your heart and other parts of your body, so it’s important to treat it. Emergency Treatments These medications include: IV insulin and glucose IV calcium IV sodium bicarbonate Inhaled albuterol
What is the first line treatment for hyperkalemia?
Calcium gluconate should be used as a first-line agent in patients with EKG changes or severe hyperkalemia to protect cardiomyocytes. Insulin and glucose combination is the fastest acting drug that shifts potassium into the cells. B-agonists can be used in addition to insulin to decrease plasma potassium levels.
How is hyperkalemia managed in the emergency department (ED)?
General Approach to Emergency Management of Hyperkalemia Place the patient on a cardiac monitor, establish IV access and obtain an ECG If the patient is stable, consider the cause and rule out pseudohyperkalemia (from poor phlebotomy technique, thrombocytosis or leucocytosis) and repeat the potassium to confirm hyperkalemia.
What is the goal of Acute therapy for hyperkalemia?
The goal of acute therapy is to stabilize the cardiomyocyte membranes to prevent arrhythmia, shift potassium into the cells, and enhance elimination of potassium from the body. Open in a separate window Fig. 1 Guide to the treatment of hyperkalemia.
How long should you perform CPR for hyperkalemia?
In cases of cardiac arrest due to hyperkalemia, perform CPR until the hyperkalemia is corrected. This may be a much longer time than usual. When ROSC is achieved, it will be primarily due to the effects of calcium rather than decreased potassium levels. The effect of calcium can last 20-30min.
Which treatments are usually ordered for hyperkalemia?
The Importance of Hyperkalemia TreatmentWater pills (diuretics), which rid the body of extra fluids and remove potassium through urine.Sodium bicarbonate, which temporarily shifts potassium into body cells.Albuterol, which raises blood insulin levels and shifts potassium into body cells.More items...
How is hyperkalemia treated in hospital?
Accepted treatments for hyperkalemia include (1) stabilization of electrically excitable membranes by administration of calcium; (2) shift of potassium from the extracellular to the intracellular compartment by means of sodium bicarbonate, insulin, or albuterol; and (3) removal of potassium from the body by sodium ...
Do you give insulin or dextrose first for hyperkalemia?
Intravenous (IV) insulin is therefore often the first-line therapy for acute hyperkalemia in hospitalized ESRD patients. It is typically used in conjunction with dextrose to prevent hypoglycemia, and is often combined with other therapies such as nebulized albuterol.
How do you treat hyperkalemia in ACLS?
For mild hyperkalemia removal of potassium from the body is achieved with diuretics which cause the release of potassium in the urine. One example of a diuretic which does not spare potassium is furosemide. Resins like Kayexalate can also be used to remove potassium from the body.
What is the best treatment for hyperkalemia?
Calcium gluconate should be used as a first-line agent in patients with EKG changes or severe hyperkalemia to protect cardiomyocytes. Insulin and glucose combination is the fastest acting drug that shifts potassium into the cells. B-agonists can be used in addition to insulin to decrease plasma potassium levels.
What is the mechanism of hyperkalemia?
The change in resting membrane potential caused by hyperkalemia is the principle pathophysiologic mechanism behind most of its symptoms. The decrease in the resting membrane potential decreases the number of sodium channels activated that in turn decrease the magnitude of inward sodium current.
What is the most reliable method to remove potassium from the body?
Hemodialysis remains the most reliable method to remove potassium from the body and should be used in cases refractory to medical treatment. Prompt detection and proper treatment are crucial in preventing lethal outcomes. Keywords: hyperkalemia, review, treatment, potassium, hyperkalemic.
What is pseudohyperkalemia?
Pseudohyperkalemia (fictitious hyperkalemia) Pseudohyperkalemia commonly arises from shifts of potassium from blood cells to blood plasma by mechanical trauma during venipuncture or during the clotting process in vitro. These effects are further enhanced when there is marked leukocytosis or thrombocytosis.
What are the distribution abnormalities of potassium?
Distribution abnormalities of potassium are seen during metabolic acidosis, insulin deficiency, aldosterone deficiency, adrenergic antagonists, and tissue damage. During metabolic acidosis, there is a significant extracellular shift of intracellular potassium in exchange for protons leading to hyperkalemia.
How long does potassium stay in the blood?
Serum potassium level starts trending down within 10–20 min of insulin and glucose administration with maximal action in 60 min: The effect lasts for 2–6 hours.
Is sodium bicarbonate effective for hyperkalemia?
Exchange resin has very slow action and is therefore indicated for treatment of chronic hyperkalemia. Hemodialysis is the most effective and reliable method to remove potassium from the body.
General Approach to Emergency Management of Hyperkalemia
Place the patient on a cardiac monitor, establish IV access and obtain an ECG
The ECG in Emergency Management of Hyperkalemia
The ECG changes associated with hyperkalemia do not always happen in a step-wise fashion with predictable serum potassium levels. Although it is generally true that higher levels of potassium correlate with progressive ECG changes, the more acute the hyperkalemia the more likely the ECG changes occur.
Determine the Cause of Hyperkalemia
First rule out pseudohyperkalemia which accounts for 20% of hyperkalemia lab values.
Medications in the Emergency Management of Hyperkalemia
There is no good literature to help guide whether calcium gluconate or calcium chloride is better for stabilizing the cardiac membrane in hyperkalemia. The most important difference to remember is that calcium chloride has 3 times more elemental calcium than calcium gluconate (6.8 mEq/10 mL vs 2.2 mEq/10 mL) and has greater bioavailability.
Hyperkalemia in Cardiac Arrest
Based on the principles of treatment and indications discussed above, our experts recommend the following approach to suspected hyperkalemia (based on patient history and rhythm strip) or confirmed hyperkalemia (based on a point of care blood gas) in cardiac arrest in addition to usual ACLS measures:
Future Directions in Emergency Management of Hyperkalemia
A new potassium binding drug, ZS-9 shows promise in the acute treatment of hyperkalemia and may make it possible to avoid or postpone the most effective therapy, emergency hemodialysis.
About the Author: Anton Helman
Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.
Why do you need dialysis for hyperkalemia?
So you might need dialysis to treat your kidney disease -- which also treats hyperkalemia.
How to get potassium down when you have hyperkalemia?
Some medications lower potassium slowly, including: Water pills (diuretics), which rid the body of extra fluids and remove potassium through urine. Sodium bicarbonate, which temporarily shifts potassium into body cells.
What medications lower potassium levels?
Some medications lower potassium slowly, including: 1 Water pills (diuretics), which rid the body of extra fluids and remove potassium through urine 2 Sodium bicarbonate, which temporarily shifts potassium into body cells 3 Albuterol, which raises blood insulin levels and shifts potassium into body cells 4 Sodium polystyrene sulfonate (Kayexalate), which removes potassium through your intestines before it’s absorbed 5 Patiromer (Veltassa), which binds to potassium in the intestines 6 Sodium zirconium cyclosilicate (Lokelma), which binds to potassium in the intestines
What is the best treatment for hyperkalemia?
Other treatment options for hyperkalemia include IV calcium, insulin, sodium bicarbonate, albuterol, and diuretics. A new drug (patiromer) was recently approved for the treatment of hyperkalemia, and additional agents are also in development.
What is hyperkalemia in adults?
Hyperkalemia is defined as a serum potassium concentration of >5.5 mEq/L in adults. 1 It is a common metabolic disorder that can lead to clinical manifestations such as hemodynamic instability, neurologic sequelae, and fatal arrhythmias.
What drugs cause hyperkalemia?
Other drugs with the potential to cause hyperkalemia include beta-blockers, succinylcholine, trimethoprim-sulfamethoxazole, non-steroidal anti-inflammatory drugs (NSAIDs), cyclosporine, heparins, tacrolimus, and excessive dosing of potassium supplements. Overdoses of digitalis or related digitalis glycosides, such as digoxin, ...
What is the best way to eliminate excess potassium?
In patients with adequate kidney function, loop diuretics (e.g., furosemide and bumetanide) in combination with thiazide diuretics can be used for the excretion of potassium.
Is potassium a life threatening electrolyte?
ABSTRACT: Hyperkalemia ( elevated serum potassium) can become a life-threatening electrolyte abnormality due to medication use, kidney dysfunction, or alternative sources of electrolyte imbalance. Up until recently, FDA-approved therapies for the management of hyperkalemia (i.e., sodium polystyrene sulfonate) had remained unchanged for over 50 years.
Is SPS good for edema?
SPS also contains a considerable amount of sodium content and should be used cautiously in patients with concomitant conditions such as congestive heart failure, edema, and severe hypertension. It is most effective when it is in the colon, where the pH level is higher than in the upper GI tract.
Can hyperkalemia be caused by medication?
Hyperkalemia can also occur secondarily to metabolic acidosis, insulin deficiency, hyperglycemia, and hyperosmolar states. Medication can also lead to hyperkalemia, most notably those agents that inhibit the renin-angiotensin-aldosterone system (RAAS).
