Type of treatment | Effect on potassium plasma level | Administration | Potential side effects | Population at risk | Preferred population |
---|---|---|---|---|---|
Myocardial protection | |||||
Calcium salt | None | 10–20 mL of calcium gluconate 10% i.v within 5 min | Hypercalcemia | Digitalis intoxication or hypercalcemia | Hyperkalemia with ECG modifications |
Hypertonic sodium (e.g., sodium bicarbonate) | − 0.47 ± 0.31 mmol/L at 30 min | 10–20 mL of sodium chloride 20% i.v within 5 min or 100 mL of 8.4% i.v sodium bicarbonate | Venous toxicity, increasing PaCO2 (due to bicarbonate) | Hypervolemia, patients with heart failure, hypernatremia, patient with respiratory insufficiency (due to bicarbonate) | Hyperkalemia with ECG modifications, patient with metabolic acidosis or AKI |
Intracellular potassium transfer | |||||
Insulin dextrose | − 0.79 ± 0.25 mmol/L at 60 min | 5 UI of rapid insulin + 25 grams of dextrose over 30 min or 10 of rapid insulin + g of dextrose or 0.5 U/kg of body weight | Hyperglycemia and hypoglycemia | All patients | Severe hyperkalemia with hourly monitoring of plasma glucose possible |
Critically ill patients at increased of hyperglycemia-related side effects | |||||
Patients with acute neurological disease | |||||
β2 mimetics | − 0.5 ± 0.1 mmol/L at 60 min | 10 mg nebulized salbutamol | Tachycardia, arrhythmias, myocardial ischemia | Patients with ischemic cardiopathy | Patient without heart failure, angina or coronary disease |
Increase plasma lactate level | Patient under β blockers therapy | Spontaneously breathing patient | |||
Elimination | |||||
Renal replacement therapy | − 1 mmol/L within minutes | High blood flow and dialysate flow in hemodialysis, high ultrafiltration rate in hemofiltration | Complications related to catheter (i.e., infection, thrombosis, hemorrhage) | Low availability of the technique | Severe renal failure, multiple organ failure |
Delay to initiate the treatment | |||||
Loop diuretics | Unpredictable | Variable | Hypovolemia, hypokalemia, hypomagnesemia | Hypovolemic patients | Hypervolemic patients with normal or moderately altered renal function |
Absorption | |||||
Sodium polystyrene sulfonate | Unpredictable (no randomized controlled trial in acute hyperkalemia) | 15 g one to four times per day | Digestive perforation, hypocalcemia, hypomagnesemia | Patients with abnormal transit, critically ill patients | Treatment of chronic hyperkalemia |
Patiromer | 0.21 ± 0.07 mmol/L within 7 h (no randomized controlled trial in acute hyperkalemia) | 8.4–25.2 g per day | Potential interaction with co-administered drugs, hypomagnesemia, potential long-term calcium disorder | Patients with abnormal transit | Treatment of chronic hyperkalemia |
ZS-9 | 0.6 ± 0.2 mmol/L within 2 h | 10 g one to three times per day | Edema | Patients with abnormal transit | Treatment of chronic and potentially acute hyperkalemia |