Hyperkalamia management is based on severity and first having to minimise its effect on cardiac muscles.
First if we suspect hyperkalamia (in patients of CKD, Burn, severe muscle disease, on ARB’s, NSAIDs, ACE inhibitors, Potassium sparing diuretics), we will first get an ECG done.
If we see hyperkalamia changes in ECG : We will first stablize myocardium.
Stop all potassium supplements (IV and oral).
Ensure adequate hydration and urine output.
until it is stable and potassium level is in range.
Onset of action is3-5 minutes (effect begins in minutes and is marked by improvement in ECG appearance.
Reduce serum K+ levels by shifting K+ from extracellular to intracellular fluid.
A- Insulin ( glucose) – Onset of action is within 15 minutes, it is fastest method.
A- Diuretics:Works only if patient has adequate kidney function.
B- Resin Exchangers (Keyexalate,sodium polystyrene sulfonate): slow acting requires 1-2 hors before K+ levels decrease.
C- Hemodialysis: Definitive treatment of choice in patients with advanced renal failure and severe hyperkalemia.