Hyperkalemia

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Hyperkalemia Treatment

Cardiac arrest (absent heartbeat) may occur at any time during treatment of hyperkalemia. Hospitalization and close monitoring is required.

ACUTE TREATMENT
The goal of acute treatment is to protect the body from the effects of hyperkalemia. This may include protective measures, shift of potassium into the intracellular fluid, and reduction of total body potassium.

Emergency treatment is indicated if the potassium is very high, or if severe symptoms are present, including changes in the ECG.

Intravenous calcium may be given to temporarily counteract the muscular and cardiac effects of hyperkalemia, including cardiac arrhythmias. Intravenous calcium will only counteract symptoms for about 1 hour, so other treatments should begin immediately.

Intravenous glucose and insulin moves potassium from the extracellular fluids back into the cells. This may reverse severe symptoms long enough to allow correction of the cause of the hyperkalemia.

Sodium bicarbonate causes potassium to shift from extracellular to intracellular fluids. It may reverse hyperkalemia caused by acidosis with no other treatment required. Prolonged use of sodium bicarbonate should be avoided because it may cause severe complications.

Diuretic medications cause decrease in total body potassium. They may be prescribed for persons who can tolerate the loss of body fluid that accompanies use of a diuretic.

Cation-exchange resins, such as sodium polystyrene sulfonate (Kayexalate), are medications that bind potassium and cause it to be excreted from the gastrointestinal tract. These medications may be given orally or rectally.

Dialysis may be used to reduce total body potassium levels, especially if kidney function is compromised. Dialysis is indicated when more conservative measures have failed or are inappropriate.

LONG-TERM TREATMENT
Long-term treatment includes treatment of the cause and associated disorders.

Treatment of chronic renal failure may include dietary potassium restriction. "Loop diuretics" may be prescribed to reduce potassium and fluid levels in persons with chronic renal failure.

Need for potassium supplements and other medications that may cause hyperkalemia should be reviewed by the health care provider. These medications may be stopped, reduced in dose, or substituted by another medication.

Salt substitute, often used by people on a low salt diet, should not be used by those with renal failure or a history of hyperkalemia.