Hyperkalemia is a common electrolyte disturbance in both inpatient and outpatient clinical practice. The severity and associated risk depends on the underlying cause and rate of K+ increase. Acute hyperkalemia requires immediate attention due to potentially life-threatening manifestations resulting from the rapid rise in plasma K+ concentration. Treatment is initially focused on stabilizing the cardiac membrane, followed by maneuvers to shift K+ into the cell, and ultimately initiating strategies to decrease total body K+ content. Chronic hyperkalemia develops over a more extended period of time and manifestations tend to be less severe. Nevertheless, the disorder is not benign since chronic hyperkalemia is associated with increased morbidity and mortality. The approach to patients with chronic hyperkalemia begins with a review of medications potentially responsible for the disorder, ensuring effective diuretic therapy, and correcting metabolic acidosis if present. The practice of restricting foods high in K+ potassium to manage hyperkalemia is being reassessed since the evidence supporting the effectiveness of this strategy is lacking. Rather, dietary restriction should be more nuanced focusing on reducing intake of non-plant sources of K+. Down titration and/or discontinuation of renin-angiotensin-aldosterone inhibitors should be discouraged since these drugs improve outcomes in patients with heart failure and proteinuric kidney disease. In addition to other conservative measures, K+ binding drugs and SGLT2 inhibitors can assist in maintaining use of these drugs.
Keywords: SGLT2 inhibitors; acute and chronic hyperkalemia; dietary potassium restriction; patiromer; renin-angiotensin-aldosterone (RAAS) inhibitors; zirconium cyclosilicate.
© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.