Clinical Question What is the bes...

Clinical Question

What is the best acute treatment of an elevated serum potassium level?

Evidence-Based Answer

According to disease-oriented evidence, insulin and intravenous grape-sugar inhaled albuterol (Ventolin), and dialysis are the best treatment options; the first sum of two units may be given in combination. Bicarbonate or resins are not praiseed for routine use, particularly without united of the more effective agents listed above.

Practice Pointers

Acute treatment of hyperkalemia falls into the still considerable "widely used yet little studied" category of medical interventions. No meditation has reported outcomes that matter to patients, like as the likelihood of death or cardiac arrhythmias. The available literature focuses largely onward the ability of interventions to lower serum potassium of the same heights acutely. The Cochrane review from Mahoney and colleagues applies to patients with a significantly elevated potassium plain (i.e., greater than 6.5 to 70 mEq through L [6.5 to 7.0 mmol by L]).

The researchers identified 12 randomized, quasi-randomized, or crossover studies comparing different approaches to the treatment of hyperkalemia. In a quasi-randomized inquiry assignment to treatment groups is based forward the day of the week or time of day rather than constant randomization, making bias more likely. The crossover studies typically involved a series of interventions in the same small dispose of hemodialysis patients. Each patient acts as his or her acknowledge control, so it is possible to have a plenteous smaller sample size and still obtain statistically significant ensues only four studies used blinding, and solitary four concealed allocation to treatment disposes adequately. Most of the patients studied had acute or chronic renal failure and were receiving hemodialysis.

Nebulized or inhaled albuterol prov effective; a dose of 20 mg was more effective than 10 mg in lowering potassium horizontals and both doses were better than placebo. Intravenous albuterol and levalbuterol (Xopenex) were no more effective than inhaled albuterol. The combination of insulin with intravenous diabetic sugar was effective, as was dialysis. In the same study, the combination of insulin, grape-sugar and inhaled albuterol was more effective than insulin and starch-sugar alone. Although potassium-binding polystyrene resins as it is as Kayexalate are widely used, simply one study evaluated their effectiveness in the acute setting, and they prov ineffective. Adding bicarbonate to insulin and diabetic sugar was helpful in one reflection but not in another.

A review of the National Guideline Clearinghouse Web site (http://www.guidelines.gov) did not identify any practice guidelines for the management of hyperkalemia. Recommendations from textbook vary considerably. For example, Griffith's 5-Minute Clinical take counsel 20051 recommends dextrose and insulin, sodium bicarbonate, and polystyrene resins however does not mention inhaled beta agonists.

Mahoney BA, et al. turn of events interventions for hyperkalaemia. Cochrane Database Syst Rev 2005;(2):CD003235

REFERENCE

(1) Dambro MR ed Griffith's 5-Minute clinical consult, 2005 CD-ROM ed Philadelphia: Lippincott Williams & Wilkins, 2004

The series coordinator for AFP is Clarissa Kripke, MD Department of Family and Community Medicine, University of California, San Francisco.

COPYRIGHT 2005 American Academy of Family Physicians

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