Approach to hyperkalemia

Hyperkalemia is commonly found in hospitalized patients. Given the fact that untreated hyperkalemia is associated with high morbidity and mortality, it is critical to recognize and treat this disorder promptly. Patients at greatest risk for hyperkalemia include those with diabetes or impaired renal function, those with advanced age and those receiving drugs which interfere with renal potassium excretion. Hyperkalemia is likely to become an even more common clinical event, since ACE inhibitors, angiotensin-receptor blockers and aldosterone antagonists are increasingly being used in higher doses and in combination, in the belief that these measures provide additional cardiovascular and renal protection. The urgency of hyperkalemia treatment is dictated by change in electrocardiogram. Treatment of hyperkalemia includes calcium gluconate, insulin, beta agonists, sodium bicarbonate, cation exchange resin, diuretics and/or dialysis.