HelixTalk Episode #107 - You’re Going to Go Bananas Over this Brief Review of Hyperkalemia

Date posted: January 14, 2020, 6:00 am

In this episode, we discuss clinical pearls and management related to chronic and acute hyperkalemia.

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Key Concepts

1. Calcium (as calcium gluconate or calcium chloride) is the most important therapy in acute hyperkalemia.  Although it does not modify serum potassium levels, it does stabilize the cardiac membrane and prevents hyperkalemia-induced arrhythmias.
2. Intravenous insulin regular (usually combined with 50% dextrose) is commonly given to redistribute potassium ions in hyperkalemia. Consider lower doses (5 units instead of 10 units) and frequent blood glucose rechecks, particularly in patients with renal impairment, because the incidence of hypoglycemia can be quite high.
3. The first-line treatment in chronic hyperkalemia involves removing underlying causes such as dietary sources, RAAS agents, potassium supplements, and NSAIDs.
4. Various new cation exchangers, such as patiromer (Veltassa) and sodium zirconium cyclosilicate (Lokelma), are now available for use in chronic hyperkalemia management.  Chronic use of these agents may allow use of RAAS agents without dose reduction but they are not studied compared to other treatment strategies such as diuretics or sodium polystyrene sulfonate (Kayexalate).