Management of patients with acute hyperkalemia

Abstract

Hyperkalemia is a common disorder, occurring both in the outpatient setting and in up to 10% of patients who have been admitted to hospital. 1^–4 Underlying renal insufficiency and use of medications that disrupt potassium balance, such as angiotensin-converting enzyme inhibitors and potassium-sparing diuretics, are well-described risk factors. 4^–7 Although mild hyperkalemia is often asymptomatic and easily treated, acute, severe hyper-kalemia that is left untreated can result in fatal cardiac arrhythmias. 8^–10 In addition to discontinuation of precipitants, steps in the management of acute hyperkalemia include protecting the heart from arrhythmias by administering calcium-based salts, 11 shifting potassium into the cells and enhancing elimination of potassium. Several treatment options have been proposed, particularly for shifting potassium into the cells, with differing onset and duration of action. 12 In addition, available studies conflict with respect to the efficacy of the various treatment options, which has led to differences in recommendations among practitioners and institutions. 5^,13