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| {{Hyperkalemia}}
| | #redirect:[[Hyperkalemia#Treatment]] |
| {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org]
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| ==Overview==
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| '''Hyperkalemia''' (AE) or '''Hyperkalaemia''' (BE) is an elevated blood level (above 5.0 mmol/L) of the [[electrolyte]] [[potassium]]. The prefix ''hyper-'' means high (contrast with ''hypo-'', meaning low). The middle ''kal'' refers to ''kalium'', which is [[Latin]] for potassium. The end portion of the word, ''-emia'', means "in the blood". Extreme degrees of hyperkalemia are considered a [[medical emergency]] due to the risk of potentially fatal [[arrhythmia]]s.
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| ==Treatment==
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| When arrhythmias occur, or when potassium levels exceed 6.5 mmol/l, emergency lowering of potassium levels is mandated. Several agents are used to lower K levels. Choice depends on the degree and cause of the hyperkalemia, and other aspects of the patient's condition.
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| * [[Calcium]] supplementation (calcium gluconate 10% (10ml), preferably through a [[central venous catheter]] as the calcium may cause [[phlebitis]]) does not lower potassium but decreases [[myocardium|myocardial]] excitability, protecting against life threatening [[arrhythmias]].
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| * [[Insulin]] (e.g. intravenous injection of 10-15u of (short acting) insulin (e.g. Actrapid) {along with 50ml of 50% dextrose to prevent hypoglycemia}) will lead to a shift of potassium ions into cells, secondary to increased activity of the [[sodium-potassium ATPase]].
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| * [[Bicarbonate]] therapy (e.g. 1 ampule (45mEq) infused over 5 minutes) is effective in cases of metabolic acidosis. The bicarbonate ion will stimulate an exchange of cellular H<sup>+</sup> for Na<sup>+</sup>, thus leading to stimulation of the [[sodium-potassium ATPase]].
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| * [[Salbutamol]] (albuterol, Ventolin<sup>®</sup>) is a β<sub>2</sub>-selective catacholamine that is administered by nebuliser (e.g. 10-20 mg). This drug promotes movement of K into cells, lowering the blood levels.
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| * [[Polystyrene sulfonate]] (Calcium Resonium, Kayexalate) is a binding resin that binds K within the intestine and removes it from the body by defecation. Calcium Resonium (15g three times a day in water) can be given by mouth. Kayexelate can be given by mouth or as an [[enema]]. In both cases, the resin absorbs K within the intestine and carries it out of the body by [[defecation]]. This medication may cause diarrhea.
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| * Refractory or severe cases may need [[dialysis]] to remove the potassium from the circulation.
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| * Preventing recurrence of hyperkalemia typically involves reduction of dietary potassium, removal of an offending medication, and/or the addition of a [[diuretic]] (such as [[furosemide]] (Lasix<sup>®</sup>) or [[hydrochlorothiazide]]).
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| ==References==
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| <references />
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| [[Category:Potassium]]
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| [[Category:Medical emergencies]]
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| [[Category:Endocrinology]]
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| [[Category:Nephrology]]
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| [[Category:Electrolyte disturbance]]
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| [[Category:Blood tests]]
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| [[Category:Emergency medicine]]
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| [[Category:Intensive care medicine]]
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