Hyperkalemia medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Treatment of hyperkalemia includes lowering of serum potassium levels,cardiac membrane stabilization and removal of excess potassium from the body.When [[Cardiac arrhythmia|arrhythmias]] occur, or when potassium levels exceed 6.5 mmol/l, emergency lowering of potassium levels is mandated. Several agents are used to lower potassium levels. Choice depends on the degree and cause of the hyperkalemia, and other aspects of the patient's condition.Treatment also depends on the cause of hyperkalemia. | Treatment of hyperkalemia includes lowering of serum [[potassium]] levels, [[cardiac membrane]] stabilization and removal of excess [[potassium]] from the [[body]].When [[Cardiac arrhythmia|arrhythmias]] occur, or when [[potassium]] levels exceed 6.5 mmol/l, [[emergency]] lowering of [[potassium]] levels is mandated. Several agents are used to lower [[potassium]] levels. Choice depends on the degree and cause of the hyperkalemia, and other aspects of the patient's condition.Treatment also depends on the cause of hyperkalemia. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacological therapy in hyperkalemia is dependent on serum potassium levels and the development of symptoms. | *[[Pharmacological]] [[therapy]] in hyperkalemia is dependent on serum [[potassium]] levels and the development of [[symptoms]]. | ||
*Therapy 1 is used in hyperkalemic emergency(emergency lowering of serum K+ required) which is : | *[[Therapy]] 1 is used in hyperkalemic [[emergency]]([[emergency]] lowering of serum K+ required) which is : | ||
**Serum potassium level >6.5 mEq/L | **Serum [[potassium]] level > 6.5 mEq/L | ||
**ECG changes present. | **[[ECG]] changes present. | ||
**Serum K+ >5.5 mEq/L and patient has severe renal impairment. | **Serum K+ >5.5 mEq/L and [[patient]] has severe [[renal impairment]]. | ||
*Therapy 2 is used when emergency lowering of potassium levels not required: | *[[Therapy]] 2 is used when [[emergency]] lowering of [[potassium]] levels not required: | ||
=== Medical management === | === Medical management === | ||
==== 1.Hyperkalemic emergency ==== | ==== 1.Hyperkalemic emergency ==== | ||
1.1. Pharmacotherapy | 1.1. [[Pharmacotherapy]] | ||
1.1.1. Cardiac membrane stabilization | 1.1.1. [[Cardiac]] membrane stabilization | ||
*Preferred regime:Calcium gluconate 10% 0.5ml/kg IV loading dose.(contraindicated in digoxin toxicity and hypercalcemia) | *Preferred regime: [[Calcium gluconate]] 10% 0.5ml/kg IV loading dose. (contraindicated in [[digoxin toxicity]] and [[hypercalcemia]]) | ||
*Alternate regime:Magnesium sulfate 2gm IV over 5 minutes(in digoxin toxicity and | *Alternate regime: [[Magnesium sulfate]] 2gm IV over 5 minutes(in [[digoxin toxicity]] and [[hypercalcemia]]) | ||
*Preferred regime( | 1.1.2. Increase [[potassium]] shift from [[extracellular]] to [[intracellular]] spaces | ||
* Preferred regime(1): IV [[insulin]] with 2.5-5 ml/kg/h 20% [[dextrose]] (0.5-1 g/kg/h) with [[insulin]] 0.2 units for every gram of glucose administered.. | |||
*Haemodialysis ( when renal function is impaired) | *Preferred regime(2): [[Salbutamol]] nebulization: 2.5 mg if <25 kg and 5 mg if >25 kg. | ||
* Alternate regime: [[Sodium bicarbonate]] 8.4%- 1-2 mmol/kg IV over 30-60 min only in cases of [[acidosis]]. | |||
1.1.3. [[Loop diuretics]] | |||
* Preferred regime: [[Furosemide]] 40mg IV laoding dose and then 1-2mg/kg/day tillpotassium levels <5.1 mEq/L. | |||
1.2 [[Renal replacement therapy]]. | |||
*[[Haemodialysis]] ( when [[renal function]] is impaired) | |||
==== 2.When emergency lowering of serum K+ not required. ==== | ==== 2.When emergency lowering of serum K+ not required. ==== | ||
2.1. Pharmacotherapy | 2.1. [[Pharmacotherapy]] | ||
2.1.1. [[Gastrointestinal]] [[cation]] exchangers | |||
*Preferred regime:[[Polystyrene sulfonate]] ([[Calcium]] Resonium, [[Kayexalate]]) given 1g/kg/ PO till serum k+ <5.1 mEq/L. | |||
2.1.2. [[Loop diuretics]] | |||
*Preferred regime: [[Furosemide]] 40mg/kg PO till serum K+ <5.1 mEq/L. | |||
2.2 [[Renal replacement therapy]] | |||
*[[Haemodialysis]](when [[renal function]] is impaired) | |||
* | |||
==== Contraindicated medications ==== | ==== Contraindicated medications ==== | ||
Revision as of 09:53, 29 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2] Jogeet Singh Sekhon Syed Ahsan Hussain, M.D.[3]
Overview
Treatment of hyperkalemia includes lowering of serum potassium levels, cardiac membrane stabilization and removal of excess potassium from the body.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 potassium levels. Choice depends on the degree and cause of the hyperkalemia, and other aspects of the patient's condition.Treatment also depends on the cause of hyperkalemia.
Medical Therapy
- Pharmacological therapy in hyperkalemia is dependent on serum potassium levels and the development of symptoms.
- Therapy 1 is used in hyperkalemic emergency(emergency lowering of serum K+ required) which is :
- Serum potassium level > 6.5 mEq/L
- ECG changes present.
- Serum K+ >5.5 mEq/L and patient has severe renal impairment.
- Therapy 2 is used when emergency lowering of potassium levels not required:
Medical management
1.Hyperkalemic emergency
1.1. Pharmacotherapy
1.1.1. Cardiac membrane stabilization
- Preferred regime: Calcium gluconate 10% 0.5ml/kg IV loading dose. (contraindicated in digoxin toxicity and hypercalcemia)
- Alternate regime: Magnesium sulfate 2gm IV over 5 minutes(in digoxin toxicity and hypercalcemia)
1.1.2. Increase potassium shift from extracellular to intracellular spaces
- Preferred regime(1): IV insulin with 2.5-5 ml/kg/h 20% dextrose (0.5-1 g/kg/h) with insulin 0.2 units for every gram of glucose administered..
- Preferred regime(2): Salbutamol nebulization: 2.5 mg if <25 kg and 5 mg if >25 kg.
- Alternate regime: Sodium bicarbonate 8.4%- 1-2 mmol/kg IV over 30-60 min only in cases of acidosis.
1.1.3. Loop diuretics
- Preferred regime: Furosemide 40mg IV laoding dose and then 1-2mg/kg/day tillpotassium levels <5.1 mEq/L.
1.2 Renal replacement therapy.
- Haemodialysis ( when renal function is impaired)
2.When emergency lowering of serum K+ not required.
2.1. Pharmacotherapy
2.1.1. Gastrointestinal cation exchangers
- Preferred regime:Polystyrene sulfonate (Calcium Resonium, Kayexalate) given 1g/kg/ PO till serum k+ <5.1 mEq/L.
2.1.2. Loop diuretics
- Preferred regime: Furosemide 40mg/kg PO till serum K+ <5.1 mEq/L.
- Haemodialysis(when renal function is impaired)
Contraindicated medications
Hyperkalemia is considered a relative contraindication to the use of the following medications:
Hyperkalemia (Serum potassium >5.5 mEq/L) is considered an absolute contraindication to the use of the following medications: