Hyperkalemia medical therapy: Difference between revisions
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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 potassium levels. Choice depends on the degree and cause of the hyperkalemia, and other aspects of the patient's condition. | 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. | ||
==Medical Therapy== | ==Medical Therapy== | ||
* [[Calcium]] supplementation (calcium gluconate 10% | * [[Calcium]] supplementation (calcium gluconate 10%), 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]]. | ||
* Magnesium sulfate is used to stabilize cardiac membrane in cases of hyperkalemia due to digoxin toxicity and hyperkalemia in hypercalcemic states. | * Magnesium sulfate is used to stabilize cardiac membrane in cases of hyperkalemia due to digoxin toxicity and hyperkalemia in hypercalcemic states. | ||
* [[Insulin]] | * [[Insulin]] will lead to a shift of potassium ions into cells, secondary to increased activity of the [[sodium-potassium ATPase]]. | ||
* [[Bicarbonate]] therapy | * [[Bicarbonate]] therapy u 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]]. | ||
* [[Salbutamol]] (albuterol, Ventolin<sup>®</sup>) is a β<sub>2</sub>-selective catacholamine that | * [[Salbutamol]] (albuterol, Ventolin<sup>®</sup>) is a β<sub>2</sub>-selective catacholamine that his drug promotes movement of K into cells, lowering the blood levels. | ||
* [[Polystyrene sulfonate]] (Calcium Resonium, Kayexalate) is a binding resin that binds K within the intestine and removes it from the body by defecation. | * [[Polystyrene sulfonate]] (Calcium Resonium, Kayexalate) is a binding resin that binds K within the intestine and removes it from the body by defecation.[[enema|nem]][[defecation|ti]]. This medication may cause diarrhea and takes a lot of time to lower the potassium levels. | ||
* Refractory or severe cases may need [[dialysis]] to remove the potassium from the circulation. | * Refractory or severe cases may need [[dialysis]] to remove the potassium from the circulation. | ||
* 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]]). | * 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]]). | ||
* [[Patiromer]] anion is a potassium binding ion cation exchange polymer that increases the [[gastrointestinal]] excretion of potassium | * [[Patiromer]] anion is a potassium binding ion cation exchange polymer that increases the [[gastrointestinal]] excretion of potassium 8.4, 16.8, and. d. [[Patiromer]] should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action. | ||
* | Hyperkalemia. | ||
Rule out pseudohyperkalemia | |||
Look for ECG changes | |||
Look for reversible causes of hyperkalemia such as supplemental potassium | |||
Look for other causes such as acidosis or Diabetic ketoacidosis and treat accordingly. | |||
1.Cardiac Membrane stabilization | |||
* If ECG changes present or sever hyperkalemia | |||
* Intravenous calcium gluconate 10% 0.5ml/kg loading dose. | |||
2.Increase potassium shift from extracellular to intracellular spaces | |||
* 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. | |||
{| class="wikitable" | |||
| colspan="1" rowspan="2" |Salbutamol (ten drops of standard sabutamol inhalation solution contain 2.5 mg) | |||
| colspan="1" rowspan="1" |iv: 4-5 μg/kg in 15 ml of 5% dextrose/water, short infusion over 15 min | |||
|- | |||
| colspan="1" rowspan="1" |Nebulized: 2.5 mg if <25 kg and 5 mg if >25 kg | |||
|} | |||
====Contraindicated medications==== | ====Contraindicated medications==== | ||
{{MedCondContrRel|MedCond = Hyperkalemia|Amiloride|Triamterene|Potassium chloride}} | {{MedCondContrRel|MedCond = Hyperkalemia|Amiloride|Triamterene|Potassium chloride}} | ||
Revision as of 15:16, 9 July 2018
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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]
Overview
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.
Medical Therapy
- Calcium supplementation (calcium gluconate 10%), preferably through a central venous catheter as the calcium may cause phlebitis) does not lower potassium but decreases myocardial excitability, protecting against life threatening arrhythmias.
- Magnesium sulfate is used to stabilize cardiac membrane in cases of hyperkalemia due to digoxin toxicity and hyperkalemia in hypercalcemic states.
- Insulin will lead to a shift of potassium ions into cells, secondary to increased activity of the sodium-potassium ATPase.
- Bicarbonate therapy u is effective in cases of metabolic acidosis. The bicarbonate ion will stimulate an exchange of cellular H+ for Na+, thus leading to stimulation of the sodium-potassium ATPase.
- Salbutamol (albuterol, Ventolin®) is a β2-selective catacholamine that his drug promotes movement of K into cells, lowering the blood levels.
- Polystyrene sulfonate (Calcium Resonium, Kayexalate) is a binding resin that binds K within the intestine and removes it from the body by defecation.nemti. This medication may cause diarrhea and takes a lot of time to lower the potassium levels.
- Refractory or severe cases may need dialysis to remove the potassium from the circulation.
- 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®) or hydrochlorothiazide).
- Patiromer anion is a potassium binding ion cation exchange polymer that increases the gastrointestinal excretion of potassium 8.4, 16.8, and. d. Patiromer should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.
Hyperkalemia.
Rule out pseudohyperkalemia
Look for ECG changes
Look for reversible causes of hyperkalemia such as supplemental potassium
Look for other causes such as acidosis or Diabetic ketoacidosis and treat accordingly.
1.Cardiac Membrane stabilization
- If ECG changes present or sever hyperkalemia
- Intravenous calcium gluconate 10% 0.5ml/kg loading dose.
2.Increase potassium shift from extracellular to intracellular spaces
- 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.
| Salbutamol (ten drops of standard sabutamol inhalation solution contain 2.5 mg) | iv: 4-5 μg/kg in 15 ml of 5% dextrose/water, short infusion over 15 min |
| Nebulized: 2.5 mg if <25 kg and 5 mg if >25 kg |
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:
Practical approach to treat Hyperkalemia
Hyperkalemia is a medical emergency if the levels of potassium are severly high or if ECG changes are present.
Hyperkalemia is treated in the following steps.