Stress-Dose Steroids: A Potential Therapeutic Option for Refractory Hyperkalemia

Area of Science:

• Nephrology
• Endocrinology

Background:

• Refractory hyperkalemia poses a significant life-threatening risk, often necessitating urgent hemodialysis.
• Multifactorial hyperkalemia can arise from conditions like acute kidney injury and adrenal insufficiency.

Observation:

• A patient presented with severe, refractory hyperkalemia due to acute kidney injury and suspected adrenal insufficiency.
• Standard treatments and excretion agents failed to resolve the hyperkalemia, leading to consideration of hemodialysis.

Findings:

• Intravenous hydrocortisone administration led to the resolution of hyperkalemia within 24 hours.
• The patient's condition improved without the need for hemodialysis, suggesting adrenal insufficiency as a key factor.

Implications:

• Clinicians should consider adrenal insufficiency and initiate stress-dose steroids for refractory hyperkalemia, even without other clear indications.
• Early steroid intervention may prevent the need for hemodialysis, reducing patient risk and healthcare costs.