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Hyperkalemia Emergency Treatment

Hyperkalemia is the condition of having too much potassium in the bloodstream. The most common cause of hyperkalemia is kidney failure; however, potassium overdose and medications that cause potassium retention can also cause hyperkalemia. While mild hyperkalemia often goes unnoticed, severe hyperkalemia can result in cardiac arrest and death. Emergency treatment for hyperkalemia revolves around shifting the potassium into cells, encouraging the excretion of potassium and supporting cardiac function.

  1. Shifting Potassium

    • High levels of potassium in the bloodstream can be counteracted by shifting the potassium across cell membranes. Potassium moves across cell membranes in response to sodium and insulin. Therefore, either sodium bicarbonate or insulin may be given via intravenous therapy to move potassium into cells and out of the bloodstream. Insulin must be given with glucose to prevent potentially life-threatening complications from low glucose.

    Removing Potassium

    • The kidneys remove potassium from the bloodstream and excrete it as urine. In those with healthy or mildly impaired kidneys, diuretics such as Lasix may be given to promote excretion. Kayexalate and other cation-exchange resins may be given, orally or as an enema, to increase potassium excretion from the gastrointestinal tract. These resins are not typically used alone in emergency situations as their action takes too long. For those with severe kidney impairment or who are having immediate cardiac complications, dialysis (the filtering of the blood by a machine) is the treatment of choice.

    Supportive Therapies

    • To help counteract the potassium's effects on muscle tissues, including the heart, calcium is given intravenously. Other supportive treatments include monitoring of electrocardiographs with preparation for immediate cardiopulmonary resuscitation and intravenous fluid therapy to promote excretion. After the emergency phase, treatment centers on finding and treating the cause for the hyperkalemia.

    Cautions

    • Always follow your organization's guidelines and algorithms for treating hyperkalemia.

      Only a physician can diagnose and properly treat hyperkalemia. Do not adjust your diet or medications without seeking your physician's advice.

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