Fast Five Quiz: Emergency Management of Hyperkalemia

A. Brent Alper, Jr, MD, MPH


March 23, 2022

After emergency management and stabilization of hyperkalemia, the patient should be admitted to the hospital. Once the potassium level is restored to normal, the potassium-lowering therapies (eg, resolution of acid-base problems, correction of coexistent electrolyte disturbances, treatment of digoxin toxicity) can be discontinued, and the serum potassium level can be monitored. Continuous cardiac monitoring should be maintained.

Definitive therapy is dialysis in patients with renal failure or when pharmacologic therapy is not sufficient. Any patient with significantly elevated potassium levels should undergo dialysis because pharmacologic therapy alone is not likely to adequately bring down the potassium levels in a timely fashion.

After discharge, potassium level test should be repeated in 2-3 days and renal function should be reevaluated if signs of renal insufficiency are present. Medications that predispose to or exacerbate hyperkalemia should be adjusted.

For patients with severe hyperkalemia or kidney failure, early consultation with a nephrologist for aid in implementing efficient therapy and plans for dialysis is highly recommended. In addition, these patients should be admitted to an intensive care unit.

Consultations with specialists may be necessary in cases of hyperkalemia that result from certain conditions or disease states:

  • Cardiologist for emergency pacemaker placement in patients with refractory heart block

  • Hematologist/oncologist for hyperkalemia resulting from tumor lysis syndrome

  • Nutritional support specialist for hyperkalemia caused by kidney failure, which requires close regulation of potassium and sodium intake

  • Endocrinologist for suspected mineralocorticoid abnormalities (eg, congenital adrenal hyperplasia)

Patients, especially those with kidney failure, must be informed about dietary sources of potassium, including salt substitutes, and their diets must be adjusted to decrease potassium dietary load. A low-potassium diet containing 2 g of potassium is recommended.

No restrictions on activity are necessary unless continuous monitoring for cardiotoxicity is required.

Learn more about the management of hyperkalemia.

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