Hyperkalemia is a potentially life-threatening condition that occurs commonly among the critically ill, most commonly in the setting of acute or chronic renal failure. Hyperkalemia can develop from a variety of mechanisms, and can even be spurious (pseudohyperkalemia). Therefore, the first step in management is to determine underlying causes. In severe cases, such as with ECG abnormalities, cardiac membrane stabilization is warranted with intravenous calcium. In addition, the fastest way to lower serum potassium is to induce intracellular potassium shifting. When total body potassium overload is present, therapies designed to promote either renal or gastrointestinal potassium removal are indicated, but take longer to have an impact (usually hours). Recently, newer potassium-binding agents have become available and may have a shorter time to effect. Hemodialysis is a highly effective option to lower hyperkalemia when medical management is ineffective.
KeywordsHyperkalemia Potassium binders Arrhythmia Acute hemodialysis
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