What are the treatment options for severe hyperkalemia?

Updated: Jun 20, 2018
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

In patients with severe hyperkalemia, treatment is as follows:

  • IV calcium to ameliorate cardiac toxicity, if present

  • Identify and remove sources of potassium intake

  • IV glucose and insulin infusion to enhance potassium uptake by cells

  • Correct severe metabolic acidosis with sodium bicarbonate

  • Consider beta-adrenergic agonist therapy (eg, nebulized albuterol, 10 mg, administered by a respiratory therapist); preferred over alkali therapy in patients with renal failure

  • Increase potassium excretion by administering diuretics or gastrointestinal cation-exchange medications

  • Emergency dialysis for patients with potentially lethal hyperkalemia that is unresponsive to more conservative measures or with complete renal failure


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