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Controversies in Management of Hyperkalemia.
J Emerg Med. 2018 May 03;:
Authors: Long B, Warix JR, Koyfman A
Abstract
BACKGROUND: Hyperkalemia is a common electrolyte disorder that can result in morbidity and mortality if not managed appropriately.
OBJECTIVES: This review evaluates the classic treatments of hyperkalemia and discusses controversies and new medications for management.
DISCUSSION: Potassium (K+) plays a key role in determining the transmembrane potentials of "excitable membranes" present in nerve and muscle cells. K+ is the predominant intracellular cation, and clinical deterioration typically ensues when patients develop sufficiently marked elevation in extracellular fluid concentrations of K+ (hyperkalemia). Hyperkalemia is usually detected via serum clinical laboratory measurement. The most severe effect of hyperkalemia includes various cardiac dysrhythmias, which may result in cardiac arrest and death. Treatment includes measures to "stabilize" cardiac membranes, to shift K+ from extracellular to intracellular stores, and to promote K+ excretion. Calcium gluconate 10% dosed 10 mL intravenously should be provided for membrane stabilization, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted. Beta-agonists and intravenous insulin should be given, and some experts recommend the use of synthetic short-acting insulins rather than regular insulin. Dextrose should also be administered, as indicated by initial and serial serum glucose measurements. Dialysis is the most efficient means to enable removal of excess K+. Loop and thiazide diuretics can also be useful. Sodium polystyrene sulfonate is not efficacious. New medications to promote gastrointestinal K+ excretion, which include patiromer and sodium zirconium cyclosilicate, hold promise.
CONCLUSIONS: Hyperkalemia can be deadly, and treatment requires specific measures including membrane stabilization, cellular shift, and excretion.
PMID: 29731287 [PubMed - as supplied by publisher]
It is wrong for the authors to conclude that SPS does not work. Older studies are in fact flawed. But Gruy-Kapral’s paper, that is THE evidence tha SPS does not work, had only SIX patients! 3 control and 3 intervention. I offer my non-scientific experience of 20 years of use to know that it works. All ED does nowadays is shift, then admit to us, and then of corse K shifts back. I have never seen a case of intestinal necrosis over these 20 years. May be because we dont use the 70% sorbitol implicated.