Evaluation and Management of Hyperkalemia

 

Upper limit of reference range for potassium:

(1) The authors use >= 5.2 mmol/L to indicate hyperkalemia.

(2) Tietz gives the following levels: for infants 5.3 mmol/L, for children 4.7 and for adolescents and adults 5.1 mmol/L

 

Management as an outpatient: if all of the following are present:

(1) mild hyperkalemia, with serum potassium <= 6.5 mmol/L

(2) stable or slowly increasing potassium concentrations

(3) minimal changes in the electrocardiogram

(4) no or mild acidemia

 

Management in the Emergency Department - if all of the following are present:

(1) moderate hyperkalemia with serum potassium 6.5 – 8.0 mmol/L

(2) changes to electrocardiogram limited to peaking of the T waves

(3) able to tolerate oral sodium polystyrene sulfate resin

(4) all causative drugs can be discontinued

(5) no supervening medical problems present

 

Management as an inpatient with monitoring - if any of the following are present:

(1) severe hyperkalemia with serum potassium > 8 mmol/L

(2) more significant arrhythmias in the electrocardiogram

(3) acute deterioration in renal function

(4) rapid increase in serum potassium levels and/or large changes from baseline concentrations

(5) unable to manage in the Emergency Department

 

Basic management:

(1) dietary counseling

(2) potassium binding resins

(3) stopping medications cause hyperkalemia if possible

(4) oral sodium citrate for patients with acidemia

(5) furosemide for patients with edema and/or hypertension

(6) oral sodium polystyrene sulfate resin

(7) restarting ACE inhibitors once potassium levels restored to normal, unless use causes an intolerable increase in potassium concentrations

 

More aggressive management: for hospitalized patients:

(1) nebulized albuterol

(2) intravenous administration of calcium gluconate

(3) insulin injections with glucose infusion

(4) intravenous sodium bicarbonate