Treatment Options For Hyperkalaemia

If hyperkalaemia is indeed real and not caused by haemolysis or a bad sample, treatment can be appropriate. It’s urgent if there are ECG changes.

  • Calcium gluconate
    • Stops membrane depolarisation
    • Does not reduce the serum potassium level
  • Sodium bicarbonate IV
    • To treat metabolic acidosis, which can be a potential underlying cause
      • Potassium moves out of cells because it exchanges with hydrogen ions
  • Insulin and glucose IV
    • Use short-acting insulin
    • To promote uptake of potassium into cells
    • Effective in kidney failure
  • Polystyrene resin orally
    • Removes potassium from bowel lumen by exchanging it for sodium or calcium
    • Comes in sodium or calcium varieties, called Resonium
      • Sodium type adds to sodium load in body
      • Calcium type avoids this but is unsuitable in hypercalcaemia
  • Dialysis
    • Last resort if extreme hyperkalaemia and nothing else works

Of course, the underlying cause should be treated; if it’s hypoaldosteronism, such as from adrenal insufficiency, corticosteroids should be given. If it’s volume depletion, that should be corrected. If the hyperkalaemia is caused by a medication, that medication should be ceased.

References

  1. Electrolyte abnormalities. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited (eTG November 2017 edition); 2017 Nov.
  2. acutecaretesting.org. (2013). On the relationship between potassium and acid-base balance. [online] Available at: https://acutecaretesting.org/en/journal-scans/on-the-relationship-between-potassium-and-acid-base-balance [Accessed 17 Feb. 2018].
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