How is potassium excretion increased in the treatment of 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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Step 4

Increase potassium excretion from the body. Renal excretion is enhanced easily in patients with normal kidney function by administering IV saline accompanied by a loop diuretic (eg, furosemide). Discontinue potassium-sparing diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), and other drugs that inhibit renal potassium excretion. Monitor volume status and aim to maintain euvolemia.

Renal excretion can be enhanced by administration of an aldosterone analogue, such as 9-alpha fluorohydrocortisone acetate. Fluorohydrocortisone is especially helpful in patients with hyporeninemia or hypoaldosteronism. It has been increasingly used in solid-organ transplant recipients who have chronic hyperkalemia from calcineurin inhibitor use. Usually, serum potassium returns to normal after about 48 hours. [68]

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