Hyperkalemia is treated by all except
|A||Insulin with glucose|
|D||K+ binding resins|
a. All patients should have exogenous sources of potassium discontinued, including potassium supplementation in intravenous fluids and enteral and parenteral solutions.
b. Potassium can be removed from the body with a cation-exchange resin, such as Kayexalate, which binds potassium in exchange for sodium. It can be administered either orally (preferreD. or rectally.
c. Measures should also include attempts to shift potassium intracellularly with glucose and bicarbonate. Nebulized albuterol (10 to 20 mg) may also be used. Glucose alone will cause a rise in insulin secretion, but in the acutely ill this response may be blunted and therefore both glucose and insulin are recommended.
d. Circulatory overload and hypernatremia may result from the administration of Kayexalate and bicarbonate, so care should be exercised when administering these agents. When ECG changes are present, calcium chloride or calcium gluconate (5 to 10 mL of 10% solution) should also be administered to counteract the myocardial effects of hyperkalemia. It should be used cautiously in patients on digitalis as digitalis toxicity may occur.
e. Dialysis should be considered when conservative measures fail.