Fast Five Quiz: Emergency Management of Hyperkalemia

A. Brent Alper, Jr, MD, MPH


March 23, 2022

Direct treatment of hyperkalemia with medication is aimed at stabilizing the myocardium, shifting potassium from the extracellular environment to the intracellular compartment, and promoting the renal excretion and gastrointestinal (GI) loss of potassium. This is done with various medications, depending on the patient's hemodynamic status, ECG, and laboratory findings (as well as comorbidity status). Treatment includes a combination of electrolytes, antidotes, diuretics, binding resins, alkalinizing agents, and beta 2–adrenergic agonists.

Electrolyte supplements are used to treat hyperkalemia and to reduce the risk for ventricular fibrillation caused by hyperkalemia. They act quickly, can be lifesaving, and are used as first-line treatment for severe hyperkalemia when the ECG shows significant abnormalities (eg, widening of QRS interval, loss of P wave, cardiac arrhythmias). Calcium usually is not indicated when the ECG shows only peaked T waves.

Insulin is administered with glucose as an antidote to facilitate the uptake of glucose into the cell, which results in an intracellular shift of potassium.

Alkalinizing agents (eg, sodium bicarbonate [Neut]) increase pH, which results in a temporary potassium shift from the extracellular to the intracellular environment. These agents enhance the effectiveness of insulin in patients with acidemia.

Learn more about the treatment of hyperkalemia in emergency medicine.


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