Hyperkalemia means high blood potassium. Potassium plays a crucial role in the electrical function of cells, particularly the transmission of currents in the heart. The inside of cells have high levels of potassium relative to the outside, and in a normal state, the cells have a negative charge inside relative to outside. If potassium levels are too high in the blood, the cells are unable to conduct electrical currents, and dangerous rhythms can develop in the heart, potentially causing death. Symptoms of hyperkalemia include weakness, nausea, palpitations and tingling.
Calcium Gluconate
Calcium gluconate is a first-line treatment for hyperkalemia associated with changes on ECG that indicate the high potassium is causing heart problems. When high potassium is present, calcium gluconate stabilizes the electrical activity of the heart, preventing the occurrence of dangerous rhythms. After calcium gluconate is administered, other treatments aim to lower the level of potassium.
Insulin and Dextrose
Insulin is a hormone released by the pancreas that shifts glucose into cells. As a side effect, doses of insulin also shift potassium out of the blood and into the cells. The effect is transient and has no effect on total body potassium. A sugar such as dextrose or glucose is added so that sugar levels to not drop too low in the blood.
Beta 2 Agonists
Beta 2 agonists are drugs that mimic the effects of the hormone epinephrine, or adrenalin. Drugs such as albuterol, also used in the treatment of asthma, shift potassium into cells. This class of drugs can be additive to the effects of insulin.
Bicarbonate
Bicarbonate is a compound in the blood that acts as a buffer. The blood maintains a careful balance of acids and bases, and bicarbonate helps to maintain the correct level of acids. As blood gets more acidic, the level of potassium in the blood rises as well from exiting the cells. Conversely, if a base such as bicarbonate is added to the blood, potassium will shift into the cells, temporarily lowering the levels.
Sodium Polystyrene Sulfonate
Sodium polystyrene sulfonate, or Kayexelate, is a drug administered into the gastrointestinal tract that exchanges sodium for potassium in the large intestine. It therefore is able to lower the level of whole body potassium. Side effects are usually gastrointestinal. The drug can cause constipation and erosion on the wall of the intestines.
Furosemide
Furosemide is a diuretic. It increases urine output by inhibiting electrolyte channels in the kidney; this causes the kidney to expel more electrolytes, including potassium, and fluids filtered from the blood. Since the fluids and electrolytes are secreted in the urine, whole body potassium is lowered.
Dialysis
Dialysis is a procedure that removes blood, filters and modifies the composition, and returns it to the body. It basically acts as an artificial kidney. If the potassium levels become too high, dialysis can be used to remove the potassium rapidly, which can be useful if the levels are extremely high. Other indications for dialysis include fluid overload, severe hypertension, metabolic acidosis and uremia.
