How is hyperkalemia treated?
Treatment of hyperkalemia must be individualized based upon the underlying cause of the hyperkalemia, the severity of symptoms or appearance of ECG changes, and the overall health status of the patient. Mild hyperkalemia is usually treated without hospitalization especially if the patient is otherwise healthy, the ECG is normal, and there are no other associated conditions such as acidosis and worsening kidney function. Emergency treatment is necessary if hyperkalemia is severe and has caused changes in the ECG. Severe hyperkalemia is best treated in the hospital, oftentimes in the intensive care unit, under continuous heart rhythm monitoring.
Treatment of hyperkalemia may include any of the following measures, either singly or in combination:
- A diet low in potassium (for mild cases).
- Discontinue medications that increase blood potassium levels.
- Intravenous administration of glucose and insulin, which promotes movement of potassium from the extracellular space back into the cells.
- Intravenous calcium to temporarily protect the heart and muscles from the effects of hyperkalemia.
- Sodium bicarbonate administration to counteract acidosis and to promote movement of potassium from the extracellular space back into the cells.
- Diuretic administration to decrease the total potassium stores through increasing potassium excretion in the urine. It is important to note that most diuretics increase kidney excretion of potassium. Only the potassium-sparing diuretics mentioned above decrease kidney excretion of potassium.
- Medications that stimulate beta-2 adrenergic receptors, such as albuterol and epinephrine, have also been used to drive potassium back into cells.
- Medications known as cation-exchange resins, which bind potassium and lead to its excretion via the gastrointestinal tract.
- Dialysis, particularly if other measures have failed or if renal failure is present.
Treatment of hyperkalemia naturally also includes treatment of any underlying causes (for example, kidney disease, adrenal disease, tissue destruction) of hyperkalemia.