Treatment of hyperkalemia in adults

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Treatment of hyperkalemia in adults

Doesthepatienthave1ormoreclinicalmanifestationsofhvoerkalemia?
Theseinclude:

&duscleweaknessorparalysis

•Cardiacconductionabnormalitiesorarmythmias*

Serumpotassium>6.5mEa/L?

Ne

Areall3ofthefollowinaoresent?
=Serumpotassium>>.>mEarl

=Significantkidneyfunctionimpairment
=Ongoingtissuebreakdown(eg,rhabdomyolysis,crushinjury,
tumorlysissyndrome)orongoingpotassiumabsorption
tea.fromsigninicantgastrointestinalbleedina)

Hyperkalemicemergency
Suchpatientsshouldbetreatedwithraoidlyactingtherabies.

includingIcalaumfirthereareEGGchangesand/ortheserum Istheserumborassium25.3mEal?
potassiumis26.3mEalIandinsulinandalucose.Inaddition.

therapiesthatremovepotassiumfromtheboovshouldbeadministered
(hemodialysis.aastrointestinalcationexchanaers.ordiuretics).

Doesthepatientnavesevere
kidneyfunctionimpairment
(ie,ESKDoroliguria)?

Doesthepatientneed

tobeovumizedforan

impendingsurgerv:

Yes No

Lowerpotassiumpromptly
Althoughtheydonotrequirerapidlyactingtherapies
le,calcium.insulin.andglucose›.suchbauentsshould
havetheirpotassiumloweredpromptly(within
6to12hours).PatientswithESKDoroliguriashouldbe
Potassiumcanbeloweredslowly
Mostofthesepatientswillhavechronicelevations
inserumpotassiumduetoCKDortheuseof
medicationsthatinhibittheRAS(orboth).
Suchpatientscanoftenbemanagedwithdietary

treatedwithdialvsis,itpossible,oragastrointestinal
cationexchanger.Otherbauentsshouldbemanaged
withreversalofthecauseofhyperkalemia(ifpossible,
ea.discontinuationofanACEinhibitor.bicarbonate
therapy(ifmetabolicacidosisispresent),diuretics
(ifhypervolemic.thecombinationofsalineinfusionwith
diuretics.oragastrointestinalcationexchanger.
modification.useofdiuretics(ifaporopriate).
bicarbonatetherapy(ifmetabolicacidosisispresent).
andreversaloffactorsthatcanproducehyperkalemia
(ea.NSAIDs.hvoovoemial.Lesscommonlv.druas
thatinhibittheRasarediscontinued.orgastrointestinal
cationexchangersareusedonachronicbasis.

ESKD: end-stage kidney disease; ACE: angiotensin-converting enzyme; CKD: chronic kidney disease; RAS: renin-
angiotensin system; NSAIDs: nonsteroidal antiinflammatory drugs; IV: intravenous; ECG: electrocardiogram.
* Cardiac manifestations of hyperkalemia are discussed in detail in the topic on clinical manifestations of hyperkalemia.
¶ Some experts given IV calcium only to patients with ECG changes. Details are presented in the topic on treatment of
hyperkalemia.

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