management of mild-moderate hyperkalaemia
Last edited 02/2018
Mild-moderate hyperkalaemia is plasma potassium in the range 5.5-6.4 mmol/l.
Identify the cause of hyperkalaemia and treat as appropriate.
The management of the hyperkalaemic patient involves:
- all patients with a serum potassium value ≥ 6.0 mmol/L should have an urgent 12-lead ECG performed and assessed for changes of hyperkalaemia
- treatment of hyperkalaemia
- to shift pottasium into cells;
- insulin-glucose (10 units soluble insulin in 25g glucose) by intravenous infusion may be used to treat moderate (potassium 6.0-6.4 mmol/L) hyperkalaemia
- nebulised salbutamol 10-20mg may be used as adjuvant therapy for moderate (potassium 6.0-6.4 mmol/L) hyperkalaemia
- remove potassium from body
- loop diuretics (frusemide at a dose of 40 to 80 mg intravenously) is useful in removing potassium load from the system when renal function is preserved
- cation exchange resins - calcium polystyrene sulfonate (CPS, K-bind powder) and sodium polystyrene sulfonate (SPS, kayexalate powder)
- works in the GI tract, exchanging potassium for calcium (in CPS) and sodium (in SPS) respectively
- address cause of hyperkalaemia and correct it
- avoid potassium sparing or retaining drugs e.g. potassium sparing diuretics (e.g. frumil), beta-blockers, ACE inhibitors, NSAIDS, aspirin
- a low potassium diet
- haemodialysis: consider if oliguric; haemodialysis is more efficient than peritoneal dialysis at removing potassium (1,2,3)
- (1) UK Renal Association 2014. Clinical practice guidelines. Treatment of acute hyperkalaemia in adults
- (2) Dasgupta A. Third in a series on hyperkalemia: current views on the treatment of hyperkalaemia. E-Journal of Cardiology Practice. 2016;14(16)
- (3) Soar J et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81(10):1400-33.