Skip to main content

Table 2 Treatments of hyperkalemia

From: Management of hyperkalemia in the acutely ill patient

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

  1. i.v intravenous, ECG electrocardiographic, β2 beta 2, ZS-9 sodium zirconium cyclosilicate