The enema form is faster; the oral route can take four to six hours because it requires the resin to get to the colon before it takes effect. Sodium polystyrene sulfonate often is given with sorbitol to decrease constipation. However, sorbitol can have intestinal complications, with reports of bowel necrosis and perforation in immunocompromised patients. Excretion of renal potassium can be increased with the use of diuretics, particularly loop diuretics e.
Patients with decreased kidney function may be relatively resistant to the effects of diuretics. If the patient is volume depleted, saline can be given with the diuretic. Hemodialysis or continuous renal replacement therapy are the treatments of last resort, with the exception of patients already receiving these therapies. Long-term treatment should be tailored to correcting the underlying cause of hyperkalemia.
Low-potassium diets should be discussed with patients, and medications that precipitated hyperkalemia should be discontinued if possible. The use of loop diuretics or fludrocortisone will be needed for patients with hyporeninemic hypoaldosteronism whose hyperkalemia recurs or is chronic. The usual dosage of f ludrocortisone is 0. In some patients, hyporeninemic hypoaldosteronism is transitory and resolves after acute management; in others, long-term management with f ludrocortisone is required.
Many patients tolerate long-term use of f ludrocortisone with no problems. The principal side effects are hypertension and f luid retention, which may respond to an added diuretic. Although the question of appropriate treatment duration with f ludrocortisone has never been studied, one approach to management would be to slowly taper f ludrocortisone on an outpatient basis, and reinstate f ludrocortisone if potassium rises.
Hyperkalemia caused by the use of ACE inhibitors or angiotensin receptor blockers in patients with chronic renal failure and metabolic acidosis may respond to sodium bicarbonate supplementation. Concomitant diuretic use limits the risk of volume overload. Already a member or subscriber? Log in.
Interested in AAFP membership? Learn more. Address correspondence to James F. Calvert, Jr. Reprints are not available from the authors. Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. Arch Intern Med. Gennari FJ. Disorders of potassium homeostasis. Hypokalemia and hyperkalemia. Crit Care Clin. Therapeutic approach to hyperkalemia. Perazella MA. Drug-induced hyperkalemia: old culprits and new offenders.
Am J Med. Drug-induced hyperkalemia [Letter Reply]. Pantanowitz L. Drug-induced hyperkalemia [Letter]. Cardiac arrest from succinylcholine-induced hyperkalemia. Am J Health Syst Pharm. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med. Nephrotoxicity in the elderly due to co-prescription of angiotensin converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs. J R Soc Med. DeFronzo RA. Hyperkalemia and hyporeninemic hypoaldosteronism.
Kidney Int. Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure. Am J Nephrol. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study investigators.
Effects of an angiotensin-converting enzyme inhibitor, Ramipril, on cardiovascular events in high-risk patients. Cardiovascular endocrinology 1: aldosterone function in diabetes mellitus: effects on cardiovascular and renal disease. J Clin Endocrinol Metab. Perazella MA, Tray K. Selective cyclooxygenase-2 inhibitors: a pattern of nephrotoxicity similar to traditional nonsteroidal anti-inflammatory drugs.
Misinterpretation of serum cortisol in a patient with hyponatremia. Diagnosis of adrenal insufficiency [published correction appears in Ann Intern Med ;]. Ann Intern Med. Becker KL. Principles and practice of endocrinology and metabolism. White PC. Disorders of aldosterone biosynthesis and action. Slovis C, Jenkins R. The transtubular potassium concentration in patients with hypokalemia and hyperkalemia. Am J Kidney Dis.
Primer on kidney diseases. Philadelphia: Elsevier Saunders, Watanabe T, Nitta K. Transient hyporeninemic hypoaldosteronism in acute glomerulonephritis. Pediatr Nephrol. Severe hyperkalemia with minimal electrocardiographic manifestations: a report of seven cases.
J Electrocardiol. Profound hyperkalemia without electrocardiographic manifestations. Charytan D, Goldfarb DS. Indications for hospitalization of patients with hyperkalemia. Williams ME. Endocrine crisis. Davey M. Calcium for hyperkalemia in digoxin toxicity.
Emerg Med J. Hyperkalemia: a potential silent killer. J Am Soc Nephrol. Treatment of hyperkalemia in renal failure: salbutamol v. Nephrol Dial Transplant. Kim HJ. Combined effect of bicarbonate and insulin with glucose in acute therapy of hyperkalemia in end-stage renal disease patients.
Intestinal necrosis associated with postoperative orally administered sodium polystyrene sulfonate in sorbitol. This content is owned by the AAFP.
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Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Jan 15, Issue. C 23 Patients with hyperkalemia and characteristic ECG changes should be given intravenous calcium gluconate. C 1 — 3 , 27 Acutely lower potassium by giving intravenous insulin with glucose, a beta 2 agonist by nebulizer, or both. C 2 , 3 , 30 Total body potassium should usually be lowered with sodium polystyrene sulfonate Kayexalate. NSAIDs Decreased prostaglandin production leads to decreased afferent arteriolar flow, suppressing renin and aldosterone secretion.
Nutritional and herbal supplements Herbs containing high potassium levels e. Penicillin G potassium Can cause hyperkalemia in patients with impaired renal function caused by increased potassium load; can be administered orally or intravenously Potassium supplements or salt substitutes Ingestion of potassium can lead to hyperkalemia, particularly if renal function is impaired; dietary sources include bananas, melon, and orange juice.
Spironolactone Aldactone Inhibits binding of aldosterone to receptors in the renal tubule Succinylcholine Anectine Increases nicotinic acetylcholine receptors in damaged skeletal muscle e.
Typical electrocardiograph changes seen in patients with hyperkalemia Reprinted with permission from Slovis C, Jenkins R. Figure 1. Values can be increased in chronic renal failure. Algorithm for the management of hyperkalemia. Management of Hyperkalemia Figure 2. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue.
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Navigate this Article. Acidosis Damage to tissue from rhabdomyolysis, burns, or trauma Familial hyperkalemic periodic paralysis Hyperosmolar states, e.
Amiloride Midamor and triamterene Dyrenium. Inhibits adrenal steroid synthesis, which can lead to aldosterone deficiency. Cyclosporine Sandimmune. Digoxin at toxic levels.
Decreases sodium-potassium ATPase activity. Glucose infusions or insulin deficiency. Herbal remedies with digitalis-like effect. Nutritional and herbal supplements. Packed red blood cells. Stored cells can partially hemolyze and release potassium when infused. Penicillin G potassium. Potassium supplements or salt substitutes. Spironolactone Aldactone. Inhibits binding of aldosterone to receptors in the renal tubule. Succinylcholine Anectine. Trimethoprim Proloprim and pentamidine Pentam This review article, which is one of eleven contained in the May issue of Seminars in Nephrology all devoted to different aspects of potassium homeostasis, provides much detail of an aspect of acid-base pathophysiology that often receives minimal explanation in medical texts.
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See also Legal info. Printed from acutecaretesting. October On the relationship between potassium and acid-base balance. Acid-base and potassium homeostasis. Seminars in Nephrology ; Read more about acid-base: Acid-base disturbance in COPD Acid-base and electrolyte disorders in CKD — a review article Acid-base disturbance in diabetes Acid-base changes during resuscitation from out-of-hospital cardiac arrest.
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