Controversial issues in the treatment of hyperkalaemia

Kamel, K. S.

doi:10.1093/ndt/gfg323

Cited by 89 publications

(48 citation statements)

References 24 publications

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“…The latter would result in reduced Na ϩ ,K ϩ -ATPase activity, leading to decreased active cellular K ϩ uptake to counteract passive K ϩ efflux through K ϩ channels. 20 The final result would be as if H ϩ had entered the cell in exchange for K ϩ . Similarly, as illustrated in Figure 3B, Na A striking observation has been that metabolic acidosis caused by mineral acid (hyperchloremic, nongap acidosis) causes a much larger shift of K ϩ into the extracellular fluid than does organic acidosis (lactic acidosis).…”

Section: Effects Of Acid-base Status On Internal K ؉ Distributionmentioning

confidence: 99%

Effects of pH on Potassium

Aronson

Giebisch

2011

Journal of the American Society of Nephrology

191

141

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Section: Effects Of Acid-base Status On Internal K ؉ Distributionmentioning

confidence: 99%

Effects of pH on Potassium

Aronson

Giebisch

2011

Journal of the American Society of Nephrology

191

141

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“…It may cause severe adverse effects (flush, tremor, anxiety, tachycardia, arrhythmias) and be hazardous particularly in patients with cardiovascular diseases and in the elderly. There have been no convincing clinical trials using beta adrenergic agonists in the management of severe hyperkalemia and some experts consider this treatment not to be evidencebased 44,45 , although some guidelines admit this therapy 46 . We do not use beta adrenergic agonists for the treatment of hyperkalemia either.…”

Section: Treatment Of Hyperkalemiamentioning

confidence: 99%

Arrhythmias and ECG changes in life threatening hyperkalemia in older patients treated by potassium sparing drugs

Berková¹,

Berka²,

Topinková³

2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Severe hyperkalemia is a life threatening condition that can cause fatal rhythm disturbance and terminal heart arrest. The most common cause of hyperkalemia in older patients is that of iatrogenic medication-related etiology due to associated polymorbidity, polypharmacy and reduced reserve metabolic capacity. The aim of this paper is to increase awareness in the clinicians of the risk of hyperkalemia in elderly patients treated by potassium sparing drugs. Methods and Results. We present two case reports of hyperkalemia ≥ 9.0 mmol/L induced by potassium sparing medications with cardiac arrhythmias and severe ECG changes including atrial asystole, disturbance of intraventricular conduction and morphological changes such as tenting T waves and deformed wide QRS complexes. The most frequent causes of hyperkalemia in elderly patients are discussed and electrocardiogram changes and arrhythmias in hyperkalemia are analyzed, as well as their treatment and prevention. Conclusion. Potassium sparing drug therapy in older persons requires more frequent monitoring especially when drugs or their doses are changed, or during concomitant acute illness.

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“…β 2 -Agonists may lower serum potassium (K + ) to a similar degree as insulin, but around one third of patients have a decline in serum K + that is <0.5 mmol/l, and therefore using these agents as monotherapy is not recommended [3]. The doses of β 2 -agonists required to lower serum K + are severalfold higher than those used in acute asthma, leading to safety concerns, especially in patients who may also have cardiac disease.…”

Section: Introductionmentioning

confidence: 99%

Bolus Administration of Intravenous Glucose in the Treatment of Hyperkalemia: A Randomized Controlled Trial

et al. 2014

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Background: Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K⁺]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose-only bolus lowers serum [K⁺] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy. Methods: A randomized, crossover study was conducted in 10 chronic hemodialysis patients who were prone to hyperkalemia. Administration of 10 units of insulin with 100 ml of 50% glucose (50 g) was compared with the administration of 100 ml of 50% glucose only. Serum [K⁺] was measured up to 60 min. Patients were monitored for hypoglycemia and EKG changes. Results: Baseline serum [K⁺] was 6.01 ± 0.87 and 6.23 ± 1.20 mmol/l in the insulin and glucose-only groups, respectively (p = 0.45). At 60 min, the glucose-only group had a fall in [K⁺] of 0.50 ± 0.31 mmol/l (p < 0.001). In the insulin group, there was a fall of 0.83 ± 0.53 mmol/l at 60 min (p < 0.001) and a lower serum [K⁺] at that time compared to the glucose-only group (5.18 ± 0.76 vs. 5.73 ± 1.12 mmol/l, respectively; p = 0.01). In the glucose-only group, the glucose area under the curve (AUC) was greater and the insulin AUC was smaller. Two patients in the insulin group developed hypoglycemia. Conclusion: Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K⁺] without any episodes of hypoglycemia.

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Controversial issues in the treatment of hyperkalaemia

Cited by 89 publications

References 24 publications

Effects of pH on Potassium

Effects of pH on Potassium

Arrhythmias and ECG changes in life threatening hyperkalemia in older patients treated by potassium sparing drugs

Bolus Administration of Intravenous Glucose in the Treatment of Hyperkalemia: A Randomized Controlled Trial

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