How is metabolic acidosis corrected in patients with hyperkalemia (high serum potassium level)?

Updated: Apr 09, 2020
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Correct metabolic acidosis with sodium bicarbonate. Because of the variable effect of different forms of metabolic acidosis on the serum potassium level, this therapeutic modality is less effective and less predictable in producing a hypokalemic response, especially in patients with chronic renal failure. Nonetheless, if the acidosis is severe, then a trial of parenteral sodium bicarbonate therapy is warranted.

Beta-adrenergic agonists also are quite effective but are perhaps somewhat more controversial and more likely to produce side effects. In the United States, the most commonly used preparation is nebulized albuterol. The dose for treating hyperkalemia, 10 mg, is substantially higher than the usual dose for the treatment of bronchospasm and requires the assistance of a respiratory therapist. The peak hypokalemic effect occurs at 90 minutes. This therapy is highly effective and is preferred to alkali therapy in patients with renal failure.

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