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      Therapeutic Approach to Hyperkalemia

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      Nephron

      S. Karger AG

      Insulin, Sodium bicarbonate, Albuterol, Dialysis, Electrocardiogram

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          Abstract

          The foremost step in the initial clinical management of hyperkalemia is to decide whether a hyperkalemic patient requires immediate treatment to avoid a life-threatening situation (serum potassium concentration >6.0 mEq/l and EKG changes). When the decision for urgent treatment of hyperkalemia is based on EKG changes, an important caveat for clinicians is that absent or atypical EKG changes do not exclude the necessity for immediate intervention. Once an urgent situation has being handled with intravenous push of a 10% calcium salt, the initiation of short-term measures can be launched by either a single or combined regimen of the three agents that cause a transcellular shift of potassium – insulin with glucose, β<sub>2</sub>-agonist (albuterol), and NaHCO<sub>3</sub>. As the first choice among these available options, we favor an intravenous bolus of 10 units of insulin with 50 ml of 50% glucose alone or in combination with 10–20 mg of albuterol by nebulizer. These can be repeated as required until the institution of hemodialysis. The combination of insulin with glucose and NaHCO<sub>3</sub> as an another option needs further clarification for its additive effects. However, NaHCO<sub>3</sub> has lost its favor because of its poor efficacy as a potassium-lowering agent when used alone. The next step is to remove potassium from the body – diuretics (furosemide), cation exchange resin (kayexelate) with sorbitol, and dialysis (preferably hemodialysis). The final important step for the managements of hyperkalemia is a long-term plan to prevent its recurrence or worsening. In addition to every effort to elucidate underlying causes and pathophysiologic mechanisms for hyperkalemia, an extensive search must be made to uncover overt or sometimes covert medications that may have led to the development of hyperkalemia. Furthermore, one must obtain detailed dietary and medical history of hyperkalemic patients.

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          Most cited references 1

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          Hyperkalemia in Dialysis Patients

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            Author and article information

            Journal
            NEF
            Nephron
            10.1159/issn.1660-8151
            Nephron
            S. Karger AG
            978-3-8055-7488-4
            978-3-318-00906-4
            1660-8151
            2235-3186
            2002
            October 2002
            18 October 2002
            : 92
            : Suppl 1
            : 33-40
            Affiliations
            Division of Nephrology, Hanyang University Kuri Hospital, Kuri, Korea
            Article
            65375 Nephron 2002;92(suppl 1):33–40
            10.1159/000065375
            12401936
            © 2002 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 1, Tables: 3, References: 34, Pages: 8
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/65375
            Categories
            Paper

            Cardiovascular Medicine, Nephrology

            Electrocardiogram, Dialysis, Albuterol, Sodium bicarbonate, Insulin

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