Treatment For Hyperkalemia



Hyperkalemia – Introduction


  • Succinylcholine (high risk)
  • Stimulation of β2 receptors (Brief spell of hyperkalemia)
  • NSAID’s
  • Combination of ACE inhibitors + potassium-sparing diuretics (Amiloride)
  • Aldosterone antagonists (Eplerenone)
  • Addison’s disease
  • Heparin (inhibits aldosterone production in adrenal glands)
  • Antimetabolites (trimethoprim – due to inhibition of epithelial Na+ channels in collecting ducts)
  • Immunosuppressive drug (cyclosporine)
  • Lithium
  • Pentamidine
  • Cytotoxics
  • Digoxin toxicity
  • ARBs (Losartan)

Treatment of Hyperkalemia

I.) For emergency hyperkalemia conditions:

  • When severe hyperkalemia (> 6.5 mEq/L), even in absence of ECG changes.
    • Eg: During cardiac toxicity & muscular paralysis.
  • Emergent treatment directs at minimizing membrane depolarization, shifting K+ into cells & promoting K+ loss.


  • Calcium gluconate administration (mainly acute cases).
    • Fast-acting & short­lived action (30–60 min).
    • Dose repeated if no ECG change after 5–10 mins.
  • MOA: Decreases membrane excitability.
  • Drug effects: 
    • Mainly counteracts hyperkalemia-induced ECG changes.
    • Antagonizes cardiac conduction due to K+ abnormalities.

II.) Other emergency treatment methods:

1. By K+ redistribution into cells:

  • Glucose + Insulin – Plasma K+ concentration falls by 0.5–1.5 mmol/L in 15–30 min.  
  • β-agonists like salbutamol – Onset of action within 30 min & effect lasts 2–4 h.
  • Bicarbonate: 
    • For severe hyperkalemia reversal in metabolic acidosis.
    • Not suitable for end­stage renal disease, due to sodium load intolerability & resultant volume expansion.

III.) Non-emergency hyperkalemia treatment:

  • Loop diuretics  By renal K+ excretion.
  • Resins [Sodium polystyrene sulfate] – By binding K+
  • Hemodialysis – By extracorporeal K+ removal.

IV.) Both emergency & non-emergency treatment:

  • Peritoneal dialysis – By peritoneal K+ removal.

Exam Important

  • Various causes for hyperkalemia include succinylcholine, combination of ACE inhibitors + potassium-sparing diuretics (Amiloride), aldosterone antagonists (Eplerenone), Heparin, NSAID’s, Lithium, digoxin toxicity, cyclosporine, trimethoprim.
  • When severe hyperkalemia (> 6.5 mEq/L), even in absence of ECG changes, calcium gluconate is administered.
  • Calcium gluconate administration is mainly used in acute hyperkalemia cases.
  • Calcium gluconate mainly counteracts hyperkalemia-induced ECG changes & antagonizes cardiac conduction due to K+ abnormalities.
  • Glucose + insulin treats hyperkalemia by redistributing K+ intracellularly.
  • β-agonists (salbutamol) is used for treating hyperkalemia.
  • Bicarbonate is used for severe hyperkalemia reversal in metabolic acidosis.
  • Glucose + insulin helps reducing plasma K+ concentration by 0.5–1.5 mmol/L in 15–30 min.  
  • Non-emergency treatment methods for hyperkalemia include loop diuretics, resins [sodium polystyrene sulfate] & by hemodialysis.
  • Peritoneal dialysis is used for both emergency & non-emergency cases of hyperkalemia.
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