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Recommendations for the management of hyperkalemia in the emergency department

Álvarez-Rodríguez E, Olaizola Mendibil A, San Martín Díez MA, Burzako Sånchez A, Esteban-Fernåndez A, Sånchez Álvarez E

Grupo de trabajo SEMES-Diabetes, Endocrinología y Metabolismo. Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain. Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain. Hospital de Basurto, Bilbao, Spain. Sociedad Española de Cardiología. Hospital Universitario de Cabueñes, Asturias, Spain. Sociedad Española de Nefrología.

Hyperkalemia, a common electrolyte disorder, is seen often in emergency departments. Patient outcomes are impacted by proper management, which requires consideration of both clinical and laboratory findings in relation to kidney function, hydration, the acid–base balance, and heart involvement. Delicate decisions about the timing of potassium level correction must be tailored in each case. For these reasons the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of Cardiology (SEC), and the Spanish Society of Nephrology (SEN) joined forces to come to a consensus on defining the problem and recommending treatments that improve hospital emergency department management of hyperkalemia. Intravenous calcium, insulin and glucose, and salbutamol continue to be used to treat acute hyperkalemia. Either loop or thiazide diuretics can help patients if volume is not depleted, and dialysis may be necessary if there is kidney failure. Ion-exchange resins are falling into disuse because of adverse effects and poor tolerance, whereas novel gastrointestinal cation-exchange resins are gaining ground and may even be of some use in managing acute cases. It is essential to adjust treatment rather than discontinue medications that, even if they favor the development of hyperkalemia, will improve a patient’s long-term prognosis. Valid alternative treatment approaches must therefore be sought for each patient group, and close follow-up is imperative.

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