Treatment and Complications of Hyperkalemia ;)

Treatment of Hyperkalemia

The cause and severity of hyperkalemia guides the management of the condition.
Mild hyperkalemia is treated on an outpatient basis using modalities such as:

• Dietary restriction of potassium rich fruits and vegetables;
• Discontinuation of all medications that increase potassium levels;
• Administration of diuretics other than potassium sparing diuretics to increase excretion of excess potassium.

Moderate to severe hyperkalemia requires additional methods of management for symptomatic relief and avoidance of recurrence.

Membrane Cell Stabilization

The first intervention is the administration of 10 % calcium chloride for protection of cardiac muscles against extreme compromise. The drug increases the threshold potential that is necessary in restoring resting membrane potential.

Increased excretion of potassium

The next intervention is increasing the excretion of potassium from the body by:

• Administration of diuretics other than potassium sparing diuretics, such as furosemide 40 mg twice a day. The dose is followed by the administration of IV fluids to avoid hypotension.
• Other drugs such as aldosterone analogues may increase potassium excretion and are administered.
• Hemodialysis is especially useful if the cause is related to renal failure as the method treats hyperkalemia and renal failure concurrently, or the patient has severe hyperkalemia that is refractory to medical treatment.

Intracellular potassium shift

Another modality of treatment is the shifting of excess potassium from the extracellular space to the intracellular space which is achieved by:

• Intravenous administration of 10 I.U of insulin, which leads to the escape of potassium back into the cells.
• Insulin dose is followed by an infusion of 50 ml of 50 % dextrose solution to control hypoglycemia.
• 10 mg of nebulized salbutamol a β-adrenergic agonist also forces a similar shift in potassium concentration.
• Sodium bicarbonate administration is important in controlling metabolic acidosis in addition to forcing a shift of potassium into the intracellular compartment.

Drugs such as kayexalate, a cation exchange resin, bind to the free potassium reducing its damaging effects.

Complications of Hyperkalemia

Due to high potassium levels, cardiac arrhythmias manifest as dysfunctional heart muscles leading to bradycardia and bundle branch blocks.

Muscle weakness and paralysis may be life-threatening, especially if involving the respiratory muscles.

Rebound hypokalemia and hypotension are also seen with aggressive diuresis.