Management of severe hyperkalemia without hemodialysis: case report and literature review

J Crit Care. 2006 Dec;21(4):316-21. doi: 10.1016/j.jcrc.2005.10.001.


Purpose: To report a case of severe hyperkalemia successfully managed without the use of hemodialysis and to provide a review of the literature regarding the management of severe hyperkalemia.

Methods: A clinical case report from the medical-surgical intensive care unit of a teaching hospital and a literature review are presented. The case involves a 59-year old man with diabetes mellitus, essential hypertension, and gout, who presented to hospital with severe hyperkalemia (K(+) = 10.4 mEq/L) and normal renal function. He was treated with intravenous fluids, sodium bicarbonate, calcium chloride, insulin, calcium resonium, and furosemide.

Results: The hyperkalemia resolved with conservative treatment within 8 hours, and dialytic therapy was not required. The literature review supported an initial conservative management approach in stable patients with intact renal function.

Conclusions: Hemodialysis is not necessary for all cases of severe hyperkalemia and should be reserved for patients with acute or chronic renal failure or those with life-threatening hyperkalemia unresponsive to more conservative measures.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Bradycardia / etiology
  • Electrocardiography
  • Fluid Therapy / methods*
  • Humans
  • Hyperkalemia / complications
  • Hyperkalemia / therapy*
  • Male
  • Middle Aged
  • Renal Dialysis
  • Treatment Outcome