HYPERKALEMIA TREATMENT GUIDELINES

This article attempts to simplify HYPERKALEMIA TREATMENT GUIDELINES. Hyperkalemia is basically a serum potassium level of greater than 5.5 mEq/l. It is a life threatening disorder. The knowledge of electrolyte imbalance with respect to potassium is critical for any physician. Hyperkalemia can lead to arrhythmias and stop the heart within seconds if severe and left untreated.

Clinically, it mainly affects the skeletal/ gut muscles and heart (cardiac muscle). There are no specific clinical signs or symptoms. They may be present with varying degree of severity. Paralytic ileus in relation to the gut muscles, generalized weakness and brady cardia may be the presenting clinical features.

Psuedo hyperkalemia , which is a falsely elevated potassium level can occur in hemolysis of RBCs in the sample and subsequent leaking and showing an elevated level of K. The sample should be repeated just to be on the safe side.

The typical EKG findings in hyperkalemia along with an elevated potassium level would confirm the diagnosis. The EKG shows, peaked T waves, PR prolongation and a wide QRS complex.

Hyperkalemia with these typical ECG changes requires urgent treatment.

Hyperkalemia Management steps

• Calcium Gluconate or Calcium chloride is used in hyperkalemia with EKG abnormalities as discussed previously. It doesn’t lower or normalize the potassium level but prevents membrane excitability reducing the risk of potentially fatal arrhythmias. The effect of Calcium Gluconate is short lived for a few hours to be max and is only the window through which one gains time for adding additional life saving measures.

• Insulin along with dextrose water/ glucose to help with the intra cellular shift of potassium. In a diabetic patient with elevated glucose levels, insulin alone will suffice. It is logical as the blood glucose is already quite high and there is no point in further raising an elevated blood glucose level.

• Sodium Bicarbonate NaHCO3 infusion also helps drive the potassium back into the cell and is especially useful if the hyperkalemia is due to acidosis. Cation exchange resins like Kayexalate removes potassium (K) from the body via fecal excretion. It is taken orally and binds the K in the gut thus helping in its elimination from the body. Loop diuretics with fluids like normal saline also help in removal of K

• Hemodialysis is most effective in removal of K in hyperkalemia management. However the decision for the patient to undergo HD should be taken as a team and not independently

• Salbutamol in a nebulized / inhaled solution can also be given in moderate to severe hyperkalaemia with ECG monitoring and keeping an eye on heart rate as it is a beta agonist and can lead to tachycardia.

So, basically both insulin and NaHCO3 redistribute the potassium within the cells rather than actually lowering it.

Cation exchange resins like Kayexalate removes potassium (K) from the body via fecal excretion. It is taken orally and binds the K in the gut thus helping in its elimination from the body.

Salbutamol in a nebulized / inhaled solution can also be given in moderate to severe hyperkalaemia with ECG monitoring and keeping an eye on heart rate as it is a beta agonist and can lead to tachycardia.

Loop diuretics with fluids like normal saline also help in removal of K

Hemodialysis is most effective in removal of K in HYPERKALEMIA TREATMENT GUIDELINES. However the decision for the patient to undergo HD should be taken as a team and not independently.