Hyperkalemia
| Measures | Onset of effect | Duration of effect |
|---|---|---|
| Cation exchange resine (e.g. 30 mg Resonium A® in 20 mL sorbitol solution p.o. (may have to be repeated) or 60 mg Resonium A® in 250 mL of fluid as enema (may have to be repeated)) | ||
| 500 mL glucose 5% i.v. + 10 IE insulin | ||
| 40 - 80 mmol sodium bicarbonate 8,4% slowly i.v. | ||
| Loop diuretics when renal function is normal or only slightly impaired | ||
| 10 mL calcium gluconate 10% slowly i.v.1 | ||
| 0.5 mg salbutamol slowly i.v. or 500 µg terbutaline s.c. or 10 - 20 mg salbutamol via nebuliser or 1.2 mg salbutamol via dosieraerosol with spacer |
||
| Hemodialysis |
| Potassium overload from external sources or cell death |
|
| Potassium shift from intracellular to extracellular |
|
| Reduced renal excretion |
|
| Increased potassium intake | |
|---|---|
| Penicillin G | Potassium containing |
| Potassium chloride, potassium citrate | Potassium containing |
| Decreased intracellular potassium shift | |
| ß-blockers | Inhibition of Na+-K+-ATPase |
| Aldosterone receptor antagonists | Inhibition of aldosterone effect on Na+-K+-ATPase |
| Digitalis glycosides | Inhibition of Na+-K+-ATPase |
| Calcineurin inhibitors | Inhibition of Na+-K+-ATPase |
| Decreased renal potassium excretion | |
| Potassium-sparing diuretics | Inhibition of renal potassium excretion |
| Trimethoprim, pentamidine | Inhibition of renal potassium excretion |
| Lithium | Inhibition of renal potassium excretion |
| Aldosterone receptor antagonists | Inhibition of aldosterone-induced effects on distal nephron |
| Indirect inhibition of aldosterone effects and other indirect effects | |
| Heparin | Inhibition of aldosterone synthesis |
| ACE inhibitors | Inhibition of conversion of angiotensin I to angiotensin II |
| Angiotensin II receptor antagonists | Inhibition of angiotensin II effects |
| Renin antagonists | Inhibition of renin effects |
| ß-blockers | Inhibition of renin production |
| NSAID and COX 2 inhibitors | Inhibition of prostaglandin-mediated stimulation of potassium excretion in collecting duct and reduced renin release |
Modified according to:
Sester U, Nephrologe 2008;3:366-74