POTASSIUM-HYPERKALEMIA MANAGEMENT (POTASSIUM LOWERING)

SUMMARY

INSULIN THERAPY
1. With dextrose 50%, 50mls IV. Insulin (actrapid) 10 units IV. BSL monitoring to monitor for hypoglycaemia. Usually ~ 1 hour post intervention.
2. Benefits of insulin: rapid effect (within 15 minutes, maximum at 1 hour, total duration 4-6 hours). K⁺ improvement 0.5 – 1.2 mmol/L.

SALBUTAMOL THERAPY
3. Rapidly acting. Inhaled = intravenous. Effects within 5 minutes. Duration ~ 4 hours. K⁺ lowering of 0.5 to 1.5 mmol/L. Effects additive to insulin/glucose therapy.
4. 2^nd line therapy. Early (1 minute) paradoxical increase in K (0.5 mmol/L). Dose related effect 10mg < 20mg.
5. Adverse effects: tachycardia, may precipitate angina and angina related cardiac arrhythmias. Animal study found induction of cardiac arrythmias in hyperkalaemic phase of salbutamol administration.

RESONIUM
6. Potassium binding resingiven orally or as an enema that exchanges Na⁺ for K⁺ across the gut wall and also induces an osmotic diarrhea full of potassium.

OTHERS
7. Sodium bicarbonate injection or infusion, if acidosis is present (30 minutes for effect; minimal response in patients without acidosis). Can precipitate decompensated heart failure.

8. Loop diuretics (in patients who make urine).
9. Dialysis. Definitive therapy but most invasive & difficult to organize.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].