Hyperkalemia
● ↓ Renal elimination
○ Na reabsorption
○ ↓ delivery of sodium and water to distal tubules
○ Reduced circulating blood volume
○ Renal failure
○ ↓ Aldosterone - Endocrine disorders (Addison’s disease)
● Drugs that ↓ potassium excretion
○ Potassium sparing diuretics
○ ACEs and ARBs
● Shift Potassium outside cells (Acidosis ↑ Potassium)
● EKG: Hypopolarization, Peaked T waves
Treatment of Acute Hyperkalemia:
● Antagonize Adverse Cardiac Effects: Calcium gluconate/Chloride
● Reverse symptoms:
○ Shift K into cells
■ Regular Insulin 10 units
■ D5W
■ Beta-Agonists (Albuterol 10-20 mg)
■ Sodium Bicarbonate 50-100 mEq
● Return Serum and Total Body Stores to Normal:
○ Non-pharmacologic: Dialysis
○ Pharmacologic: Furosemide 20-40 mg IV
Treatment of Chronic Hyperkalemia:
● Return serum and total body stores to normal
● Reverse underlying process
● Non-pharmacologic: Diuresis
● Pharmacologic:
○ Diuretics: Furosemide 20-40 mg by mouth or Bumetanide 1-2 mg by mouth
○ Increase GI elimination: Potassium Binders
■ Patiromer and Sodium Cyclosilicate (Powder packets)
● Patiromer
○ Calcium-Potassium ion exchange
○ Also binds Mg
○ No sodium content
○ Dose: 8.4 g once daily (max 25.2 g daily)
○ Side effects: GI, hypomagnesemia
○ Interactions: Separate by at least 3 hours from other meds
● ↓ Renal elimination
○ Na reabsorption
○ ↓ delivery of sodium and water to distal tubules
○ Reduced circulating blood volume
○ Renal failure
○ ↓ Aldosterone - Endocrine disorders (Addison’s disease)
● Drugs that ↓ potassium excretion
○ Potassium sparing diuretics
○ ACEs and ARBs
● Shift Potassium outside cells (Acidosis ↑ Potassium)
● EKG: Hypopolarization, Peaked T waves
Treatment of Acute Hyperkalemia:
● Antagonize Adverse Cardiac Effects: Calcium gluconate/Chloride
● Reverse symptoms:
○ Shift K into cells
■ Regular Insulin 10 units
■ D5W
■ Beta-Agonists (Albuterol 10-20 mg)
■ Sodium Bicarbonate 50-100 mEq
● Return Serum and Total Body Stores to Normal:
○ Non-pharmacologic: Dialysis
○ Pharmacologic: Furosemide 20-40 mg IV
Treatment of Chronic Hyperkalemia:
● Return serum and total body stores to normal
● Reverse underlying process
● Non-pharmacologic: Diuresis
● Pharmacologic:
○ Diuretics: Furosemide 20-40 mg by mouth or Bumetanide 1-2 mg by mouth
○ Increase GI elimination: Potassium Binders
■ Patiromer and Sodium Cyclosilicate (Powder packets)
● Patiromer
○ Calcium-Potassium ion exchange
○ Also binds Mg
○ No sodium content
○ Dose: 8.4 g once daily (max 25.2 g daily)
○ Side effects: GI, hypomagnesemia
○ Interactions: Separate by at least 3 hours from other meds
