Too Much Potassium (Hyperkalemia): Drug Therapy

Therapeutic targets

Therapy recommendations

  • Acute hyperkalemia (potassium value: > 6.5 mmol/l) and/or previous cardiac damage or ECG changes represent an emergency situation → intensive medical monitoring required!
  • Discontinuation of causative drugs (see below medical history).
  • Causal therapy of causative diseases (see under the respective disease).
  • Restriction of enteral (“via the intestine”) potassium intake.
  • Stabilization of the resting membrane potential of the heart muscle cells and the conduction system to prevent cardiac arrhythmias: Calcium i.v. (= intravenously, i.e. into the vein); available for i.v. use in Germany:
    • Calcium gluconate 10% (2.26 mmol Ca 2+ in 10-ml amp.) [less tissue toxic].
    • Calcium chloride 10% (6.8 mmol Ca 2+ in 10-ml amp).

    Minimum dose: 6.8 mmol Ca 2+ (≡ 30 ml calcium gluconate 10 % or 10 ml calcium chloride 10 %).

  • Infiltration of potassium into the cells:
  • Promotion of diuresis:
    • Loop diuretics (diuretic medications), e.g., fuosemide, i.v. + 0.9% NaCl solution (physiologic saline)
    • Cation exchangers (oral or rectal/via the rectum): ion exchange resins that exchange K +- for Na +-ions in the intestine (not suitable as acute therapy, as elimination is insufficient).
  • If necessary, also passive hemodialysis (blood washing) (target clinic should be selected accordingly).
  • Prophylaxis or secondary prevention of hyperkalemia (impaired renal function and potassium value approaches 5 mmol/l): administration of cation exchangers (eg, sodium salt of polystyrene sulfonate (NaPSS), calcium salt of polystyrene sulfonate (CaPSS), Patiromer (Patiromersorbitx calcium)).
  • Measures in mild hyperglycemia: see under “Further therapy“.