Treatment of Severe Hyperkalemia: Confronting 4 Fallacies

Abstract

Severe hyperkalemia is a medical emergency that can cause lethal arrhythmias. Successful management requires monitoring of the electrocardiogram and serum potassium concentrations, the prompt institution of therapies that work both synergistically and sequentially, and timely repeat dosing as necessary. It is of concern then that, based on questions about effectiveness and safety, many physicians no longer use 3 key modalities in the treatment of severe hyperkalemia: sodium bicarbonate, sodium polystyrene sulfonate (Kayexalate [Concordia Pharmaceuticals Inc., Oakville, ON, Canada], SPS [CMP Pharma, Farmville, NC]), and hemodialysis with low potassium dialysate. After reviewing older reports and newer information, I believe that these exclusions are ill advised. In this article, I briefly discuss the treatment of severe hyperkalemia and detail why these modalities are safe and effective and merit inclusion in the treatment of severe hyperkalemia.

Emergency Potassium Normalization Treatment Including Sodium Zirconium Cyclosilicate: A Phase II, Randomized, Double‐blind, Placebo‐controlled Study (ENERGIZE)

“…Dialysis is extremely effective, but logistic issues often preclude its rapid implementation 7 . Potassium binders, such as sodium polystyrene sulfonate (SPS) and patiromer, may be effective, but evidence regarding efficacy and onset of action is varied 8,9 . SPS has been reported to cause severe gastrointestinal (GI) side effects, including colonic necrosis 10,11 .…”

Гиперкалиемия И Хроническая Болезнь Почек

“…Відносно велика поширеність гіперкаліємії в пацієнтів зі стабільною нефрологічною допомогою, навіть в ідеальних умовах рандомізованих досліджень із кращим лікуванням і моніторингом, вказує на те, що нинішні стратегії, спрямовані на профілактику й лікування гіперкаліємії, не є оптимальними. Терапевтичне питання стає ще більш критичним при розгляді прогностичної цінності високих рівнів сироваткового калію (СК) [1,2]. Дійсно, ризик смертності підвищується вже навіть при гіперкаліємії малого ступеня (табл.…”

Hyperkalemia: A persisting risk. A case report and update on current management

“…5,23 Table 1 gives an overview of pharmacologic therapeutic approaches. T A B L E 1 Routinely used substances in the treatment approach of hyperkalemia 5,25,26 Interestingly, potassium elimination is often underrepresented in therapeutic summaries (eg, by the European Resuscitation Council 5 ), and the use of furosemide could even be complemented by other diuretics (such as acetazolamide in nonacidotic patients). 24 Apart from the medication depicted in Table 1, the general use of sodium bicarbonate is controversial in nonacidotic patients, although its value is undisputed in patients with low pH levels.…”

“…Finally, hemodialysis is the most effective way of potassium elimination but requires substantial clinical effort and resource management. 5,17,25,26 New drug developments with doubtable beneficial features in emergency situations have been introduced in the recent past: Patiromer, a synthetic polymer, exchanges calcium and potassium intestinally, therefore promoting fecal potassium excretion. Its long onset time (7-48 hours) and effect duration (12-24 hours) render Patiromer unpracticable for critical care, although it can be seen as an addition to the other options for long-term potassium decrement.…”

“…30,31 Since acidosis leads to a shift of potassium from the intra-to the extracellular space through K + /H + exchange, the administration of isotonic saline may aggravate hyperkalemia. 6,32 Typical complications in some of the therapeutic interventions include hypoglycemia due to insulin overdose and rebound hyperkalemia after the initial therapeutic effect has worn off; close electrolyte monitoring must be maintained at all times.. 5,17,25,27 2 | CASE PRESENTATION…”