Treatment of hyperkalemia

Abstract

Introduction: The pathophysiology of potassium imbalances has been a dynamic area of medical research over the years. Controversy exists about the effectiveness and safety of various treatment strategies for hyperkalemia.

Areas covered: The following discussion reviews potassium homeostasis, highlights common etiologies responsible for hyperkalemia and describes the associated clinical manifestations. An in-depth discussion about treatment strategies focuses on: i) stabilizing myocardial cell membranes, ii) enhancing cellular uptake of potassium and iii) the removal of excess potassium. The data for safety and efficacy of various therapies are reviewed.

Expert opinion: Certain aspects of treating hyperkalemia remain controversial. Serum potassium is tightly regulated within a narrow range and precisely assessing the degree of risk associated with a given degree of hyperkalemia can be difficult. For this reason, it's important to individualize treatment strategies. Concerns regarding the risks of calcium administration in patients with digitalis toxicity continue to impact practice patterns for hyperkalemia. A review of the literature in this area allows us to apply reasonable caution in these situations. Finally, reviewing the incidence of adverse events associated with low potassium dialysate solutions provides insight into the safety of this practice.

Keywords::

• calcium gluconate
• hyperkalemia
• potassium homeostasis
• renal potassium excretion
• sodium polystyrene sulfonate
• transcellular potassium shifting

Notes

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