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:

• ECG
  • 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)

Reference:

• (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.