Nephrol Dial Transplant (2003) 18: 2215-2218
© 2003 European Renal Association-European Dialysis and Transplant Association
Editorial Comment
Controversial issues in the treatment of hyperkalaemia
1Renal Division, St Michael’s Hospital, University of Toronto, Toronto and 2Renal Division, Lakeridge Health Corporation, Oshawa, Canada
Correspondence and offprint requests to: K. S. Kamel, MD, St Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. Email: kamel.kamel@utoronto.ca
Keywords: ß2-adrenergic agents; cation-exchange resins; hyperkalaemia; insulin; sodium bicarbonate; treatment
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Introduction
Hyperkalaemia is a frequent medical emergency that can cause life-threatening cardiac arrhythmias [1]. Its management remains controversial [2]. We shall examine the clinical evidence for therapies used to induce a shift of potassium (K+) into cells and the role of cation-exchange resins.
Insulin
Several clinical studies support the use of insulin for the treatment of acute hyperkalaemia in patients with end-stage renal disease (ESRD) [3–7]. Blumberg et al. [3] showed that the administration of close to 20 units of regular insulin with glucose caused the plasma potassium (PK) to fall rapidly; a drop of close to 1 mM was observed at 60 min. Supraphysiological levels of insulin in plasma are required for maximal K+ shift. Hypoglycaemia is a frequent complication [3]. Supplementary parenteral glucose and blood glucose monitoring are essential.
Although some advocate treating non-diabetic hyperkalaemic
ß2-adrenergic agonists
NaHCO3
Cation-exchange resins
Conclusions
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