TREATMENT FOR HYPERKALEMIA

TREATMENT FOR HYPERKALEMIA

Hyperkalemia – Introduction

Causes:

• 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.

Treatment:

• 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.

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