Is Transcellular Potassium Shifting With Insulin, Albuterol, or Sodium Bicarbonate in Emergency Department Patients With Hyperkalemia Associated With Recurrent Hyperkalemia After Dialysis?

Klein, Lauren R.; Chittineni, Chaitanya; Cales, Ellen K.; Scott, Nathaniel L.

doi:10.1016/j.jemermed.2018.02.012

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…This reduces abnormal myocardial conduction from increased potassium, and is a temporary ‘fix’ at best 41. However, there is uncertainty whether transcellular shifting causes insufficient potassium removal during hemodialysis, resulting in a subsequent need for further medical therapy or multiple sessions of hemodialysis 42…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review

Varallo¹,

Trombotto

Lucchetta

et al. 2019

Pharm Pract (Granada)

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Background: Although the management of hyperkalemia follows expert guidelines, treatment approaches are based on traditionally accepted practice standards. New drugs have been assessed such as sodium zirconium cyclosilicate and patiromer; however, their safety and efficacy or effectiveness have not yet been compared to traditional pharmacotherapy. Objective: The present systematic review had the purpose to evaluate the efficacy, effectiveness, and safety of hyperkalemia pharmacotherapies. Methods: PubMed, LILACS, Cochrane Library, and ClinicalTrials were searched through November 2018. Clinical trial, cohort and case-control were searched. The risk of bias (RoB v2.0 and ROBINS-I) and quality of evidence (GRADE) at the level of outcomes were assessed. Results: Sixteen clinical trials and one retrospective cohort were identified regarding efficacy and safety of 24 different alternatives. The management of hyperkalemia remains empirical and off-label, since sodium zirconium cyclosilicate and patiromer are not available in several countries and further studies are required to assess efficacy, effectiveness and safety. Sodium or calcium polystyrene sulfonate (moderate confidence), sodium zirconium cyclosilicate (moderate confidence), and insulin plus dextrose (moderate confidence) showed superior efficacy to, respectively, placebo, no treatment, placebo, and dextrose. Other therapies (low confidence) showed similar efficacy compared to active or inactive alternatives. Most of the adverse events reported were nonspecific, so it was not possible to assign the cause and to classify as defined or probable. Conclusions: Comparative cohort and case-control studies are need to evaluate the safety and effectiveness of new and traditional pharmacotherapies to support the development of guidelines about acute and chronic hyperkalemia, with high-quality evidence.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review

Varallo¹,

Trombotto

Lucchetta

et al. 2019

Pharm Pract (Granada)

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Correction of Electrolyte Abnormalities in Critically Ill Patients

Bulloch,

Cardinale-King,

Cogle

et al. 2024

Intensive Care Res

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Introduction The majority of patients in the intensive care unit (ICU) are at risk for at least one electrolyte abnormality and critically ill patients are the most vulnerable population to the effects of suboptimal electrolyte levels. These patients have unique characteristics impacting implications of the electrolyte disturbances and management. Areas Covered In the ICU, magnesium, potassium, calcium, phosphorous, and sodium are the most commonly encountered electrolytes that can be abnormal in the critically ill. Critical illness both is affected by and affects disturbances of these electrolytes which can result in more severe illness, longer duration of mechanical ventilation, increased dialysis support, longer length of stay, and increased mortality. Often, patients have multiple imbalances that require correction. Removal or mitigation of the cause should be undertaken whenever possible and should be concurrent with any therapeutic management used to correct the electrolyte imbalance. Selection of medication to correct electrolyte imbalances should be undertaken according to available evidence and drug-specific characteristics that impact medication delivery in the critically ill. Electrolyte disturbances, measurements, and corrections are ubiquitous in the ICU. Published literature on the management of electrolytes in the critically ill is limited. Management should consider factors unique to the critically ill when selecting optimal treatment approach and it is essential to individualize treatment to a patient’s unique needs and adapt management to the patient’s chancing clinical situation.

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Is Transcellular Potassium Shifting With Insulin, Albuterol, or Sodium Bicarbonate in Emergency Department Patients With Hyperkalemia Associated With Recurrent Hyperkalemia After Dialysis?

Cited by 2 publications

References 9 publications

Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review

Efficacy and safety of the pharmacotherapy used in the management of hyperkalemia: a systematic review

Correction of Electrolyte Abnormalities in Critically Ill Patients

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