Purpose: To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients.
Methods: We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: "hyperkalemia," "intensive care," "acute kidney injury," "acute kidney failure," "hyperkalemia treatment," "renal replacement therapy," "dialysis," "sodium bicarbonate," "emergency," "acute." Reports from within the past 10 years were selected preferentially, together with highly relevant older publications.
Results: Hyperkalemia is a potentially life-threatening electrolyte abnormality and may cause cardiac electrophysiological disturbances in the acutely ill patient. Frequently used therapies for hyperkalemia may, however, also be associated with morbidity. Therapeutics may include the simultaneous administration of insulin and glucose (associated with frequent dysglycemic complications), β-2 agonists (associated with potential cardiac ischemia and arrhythmias), hypertonic sodium bicarbonate infusion in the acidotic patient (representing a large hypertonic sodium load) and renal replacement therapy (effective but invasive). Potassium-lowering drugs can cause rapid decrease in serum potassium level leading to cardiac hyperexcitability and rhythm disorders.
Conclusions: Treatment of hyperkalemia should not only focus on the ability of specific therapies to lower serum potassium level but also on their potential side effects. Tailoring treatment to the patient condition and situation may limit the risks.
Keywords: Acute kidney injury; Emergency; Hyperkalemia; Intensive care; Renal replacement therapy.
Conflict of interest statement
Dr. Dépret has nothing to disclose. Dr. Peacock reports grants and personal fees from Astra Zeneca, grants and personal fees from Relypsa, outside the submitted work. Dr. Liu reports grants from NIH: National Heart, Lung and Blood Institute, grants from NIH: National Institute of Diabetes and Digestive and Kidney Disease, personal fees from Achaogen, personal fees from Durect, personal fees from Z S Pharma, personal fees from Theravance, personal fees from Quark, personal fees from Potrero Med, other from Amgen, grants from American Society of Nephrology, grants from National Kidney Foundation, grants from National Policy Forum on Critical Care and Acute Renal Failure, personal fees from Baxter, outside the submitted work. Dr. Rafique reports personal fees and other from AstraZeneca, grants and personal fees from Vifor, outside the submitted work. Dr. Rossignol reports personal fees from French National Research Agency Fighting Heart Failure (ANR-15-RHU-0004), personal fees from French PIA project «Lorraine Université d’Excellence» GEENAGE (ANR-15-IDEX-04-LUE) programs, outside the submitted work. Dr. Legrand reports grants from French ministry of health, grants and nonfinancial support from Sphingotec, personal fees from Fresenius, personal fees from Baxter-Hospal, and personal fees from Novartis, outside the submitted work.
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