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Hyperkalemia (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is hyperkalemia?
- How does hyperkalemia affect the body?
- What are the symptoms of hyperkalemia?
- What causes hyperkalemia?
- Kidney dysfunction
- Diseases of the adrenal gland
- Potassium shifts
- Medications
- How is hyperkalemia diagnosed?
- How is hyperkalemia treated?
- Find a local Internist in your town
How is hyperkalemia treated?
Treatment of hyperkalemia must be individualized based upon the underlying cause of the hyperkalemia, the severity of symptoms or appearance of ECG changes, and the overall health status of the patient. Mild hyperkalemia is usually treated without hospitalization especially if the patient is otherwise healthy, the ECG is normal, and there are no other associated conditions such as acidosis and worsening kidney function. Emergency treatment is necessary if hyperkalemia is severe and has caused changes in the ECG. Severe hyperkalemia is best treated in the hospital, oftentimes in the intensive care unit, under continuous heart rhythm monitoring.
Treatment of hyperkalemia may include any of the following measures, either singly or in combination:
- A diet low in potassium (for mild cases).
- Discontinue medications that increase blood potassium
levels.
- Intravenous administration of glucose and insulin,
which promotes movement of potassium from the extracellular space back into
the cells.
- Intravenous calcium to temporarily protect the heart
and muscles from the effects of hyperkalemia.
- Sodium bicarbonate administration to counteract
acidosis and to promote movement of potassium from the extracellular space
back into the cells.
- Diuretic
administration to decrease the total potassium stores through increasing
potassium excretion in the urine. It is important to note that most diuretics increase
kidney excretion of potassium. Only the potassium-sparing diuretics mentioned
above decrease kidney excretion of potassium.
- Medications that stimulate beta-2 adrenergic receptors, such as albuterol
and epinephrine, have also been used to drive potassium back into cells.
- Medications known as cation-exchange resins, which
bind potassium and lead to its excretion via the gastrointestinal tract.
- Dialysis, particularly if other measures have failed
or if renal failure
is present.
Learn more about: Sodium bicarbonate
Treatment of hyperkalemia naturally also includes treatment of any underlying causes (for example, kidney disease, adrenal disease, tissue destruction) of hyperkalemia.
Previous contributing author Dennis Lee, MD
Last Editorial Review: 3/7/2008
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