TREATMENT FOR HYPERKALEMIA
TREATMENT FOR HYPERKALEMIA
Hyperkalemia – Introduction
- Succinylcholine (high risk)
- Stimulation of β2 receptors (Brief spell of hyperkalemia)
- 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)
- 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.
- 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.
- 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.