1.1 Myth #1: Kayexalate is safe and useful
- Flinn R.B.
- Merrill J.P.
- Welzant W.R.
- Scherr L.
- Ogden D.A.
- Mead A.W.
- Spritz N.
- Rubin A.L.
Recommendation: Due to the potential harm and lack of efficacy, SPS should not be routinely included in the management of acute hyperkalemia.
1.2 Myth #2: Lactated Ringer's is contraindicated in hyperkalemia
- Self W.H.
- Semler M.W.
- Wanderer J.P.
- et al.
Recommendation: Lactated Ringer's solution is safe and appropriate for use in patients with hyperkalemia.
1.3 Hyperkalemia Myth #3: the EKG changes from hyperkalemia are predictable and reliable
1.3.1 EKG Changes Associated With Hyperkalemia
1.3.2 A Normal EKG Does Not Exclude Hyperkalemia
1.3.3 EKG Changes may help predict adverse outcomes in hyperkalemia
Recommendation: A normal EKG does not exclude hyperkalemia, however it is associated with a decreased likelihood of serious adverse events.
1.4 Myth #4: all patients with hyperkalemia should be treated with calcium
1.4.1 Clinical use
Recommendation: Treatment with intravenous calcium is indicated only for patients with hyperkalemia manifesting EKG changes.
Declaration of Competing Interest
Appendix A. Appendix 1
A.1 A brief review of potassium physiology and the effect of hyperkalemia on the EKG tracing
- Toporek A.H.
- Semler M.W.
- Self W.H.
- et al.
Appendix B. Appendix 2
B.1 Calcium antagonizes the electrochemical consequences of hyperkalemia
- Trends in emergency room visits due to hyperkalemia in the United States.Value Health. 2015; 18: 386
- Prevalence and economic burden of hyperkalemia in the United States medicare population.Curr Med Res Opin. 2020; 36: 1333-1341
- The Cost of Hyperkalemia in the United States.Kidney Int Reports. 2018; 3: 385-393
- Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and/or diabetes.Am J Nephrol. 2017; 46: 213-221
- Real world evidence for treatment of hyperkalemia in the emergency department (REVEAL–ED): a multicenter, prospective, observational study.J Emerg Med. 2018; 55: 741-750
- Current treatment and unmet needs of hyperkalemia in the emergency department.Eur Heart J Suppl: J Eur Soc Cardiol. 2019; 21: A12-A19
- Tintinalli’s emergency medicine: a comprehensive study guide.Ninth edition. ed. McGraw-Hill, New York2020
- Ion-exchange resins in the treatment of anuria.Lancet (London, England). 1953; : 265
- Treatment of the Oliguric Patient with a New Sodium-Exchange Resin and Sorbitol.vol. 264. 1961: 111-115https://doi.org/10.1056/NEJM196101192640302
- Management of Hyperkalemia with a Cation-Exchange Resin.1961https://doi.org/10.1056/NEJM196101192640303
- FDA and Clinical Drug Trials: A Short History. A Quick Guide to Clinical Trials.Bioplan, Inc, Washington2008
- Effect of single dose resin-cathartic therapy on serum potassium concentration in patients with end-stage renal disease.J Am Soc Nephrol: JASN. 1998; 9
- Treatment of hyperkalemia in patients with chronic kidney disease: a comparison of calcium polystyrene sulphonate and sodium polystyrene sulphonate.J Ayub Med Coll Abbottabad: JAMC. 2014; 26
- Randomized clinical trial of sodium polystyrene sulfonate for the treatment of mild hyperkalemia in CKD.Clin J Am Soc Nephrol: CJASN. 2015; 10
- Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia.Clin Exp Nephrol. 2017; 22: 35-44
- polysulfonate resins in hyperkalemia: a systematic review.Can J Kidney Health Dis. 2020; 7: 1-19
- Emergency interventions for hyperkalaemia.Cochrane Database Syst Rev. 2005; (Art. No.: CD003235): 6-38
- Pharmacological interventions for the acute management of hyperkalaemia in adults - Batterink, J - 2015|Cochrane Library.Cochrane Database Syst Rev. 2015; (Art. No.: CD010344): 11-12
- Potassium binders for chronic hyperkalaemia in people with chronic kidney disease.Cochrane Database Syst Reviews. 2020; : 6
- Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review.Am J Med. 2013; 126
- Risk of hospitalization for serious adverse gastrointestinal events associated with sodium polystyrene sulfonate use in patients of advanced age.JAMA Intern Med. 2019; 179
- Initiation of sodium polystyrene sulphonate and the risk of gastrointestinal adverse events in advanced chronic kidney disease: a nationwide study.Nephrol Dial Transpl: Off Public Eur Dial Transpl Assoc - Eur Renal Assoc. 2020; 35
- Adverse gastrointestinal effects with kayexalate or kalimate: a comprehensive review.Clin Exp Gastroenterol. 2021; 14: 1-18
- Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: improving global outcomes conference.Eur J Emerg Med: Off J Eur Soc Emerg Med. 2020; : 27
Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142.
- Emergency management of severe hyperkalemia: guideline for best practice and opportunities for the future.Pharmacol Res. 2016; 113: 585-591
- To bind or to let loose: effectiveness of sodium polystyrene sulfonate in decreasing serum potassium.Int J Nephrol. 2012; 2012: 5
- Effectiveness of Sodium polystyrene sulfonate for short-term treatment of hyperkalemia.Can J Hospital Pharm. 2015; 64: 296-303
- Polysulfonate resins in hyperkalemia.Syst Rev. 2020; 7
- Balanced crystalloids versus saline in noncritically ill adults.N Engl J Med. 2018; 378: 819-828https://doi.org/10.1056/NEJMoa1711586
- Balanced crystalloids versus saline in critically ill adults.N Engl J Med. 2018; 378: 829-839
- Myth-busting: Lactated Ringers is safe in hyperkalemia, and is superior to NS.
- Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery.Anesthesiology. 1999; 90: 1265-1270
- A comparative study of impact of infusion of ringer’s lactate solution versus normal saline on acid-base balance and serum electrolytes during live related renal transplantation.Saudi J Kidney Dis Transpl. 2012; 23: 135-137
- A randomized, double-blind comparison of lactated Ringer’s solution and 0.9% NaCl during renal transplantation.Anesth Analg. 2005; 100: 1518-1524
- Relationship between blood pH and potassium and phosphorus during acute metabolic acidosis.Am J Phys. 1978; 235: 345-351
- Balanced crystalloids versus saline in critically ill adults with hyperkalemia or acute kidney injury: secondary analysis of a clinical trial.Am J Respir Crit Care Med. 2021; 203: 1322-1325https://doi.org/10.1164/rccm.202011-4122LE
- The effect of potassium on atrioventricular conduction of normal dogs.Am J Cardiol. 1963; 11: 487-492
- Electrocardiographic effects of potassium. I. Perfusion through the coronary bed.Am Heart J. 1964; 67: 357-363
- Hyperkalemia: ECG manifestations and clinical considerations.J Emerg Med. 1986; 4: 449-455
- Hyperkalemia revisited.Tex Heart Inst J. 2006; 33: 40-47
- Hyperkalemia, cardiac conduction, and the electrocardiogram: a review.Am Heart J. 1974; 88: 360-371
- Electrocardiographic manifestations of hyperkalemia.Am J Emerg Med. 2000; 18: 721-729
- Profound hyperkalemia without electrocardiographic manifestations.Am J Kidney Dis. 1986; 7: 461-465
- Atypical electrocardiographic changes in severe hyperkalemia.Am J Cardiol. 1996; 77: 906-908
- Recurrent life-threatening hyperkalemia without typical electrocardiographic changes.J Electrocardiol. 2014; 47: 95-97
- Severe hyperkalemia with minimal electrocardiographic manifestations: a report of seven cases.J Electrocardiol. 1999; 32: 45-49
- Rapid electrocardiogram evolution in a dialysis patient.J Emerg Med. 2016; 50: 497-500
- Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines.Arch Intern Med. 1998; 158: 917-924
- Retrospective review of the frequency of ECG changes in hyperkalemia.Clin J Am Soc Nephrol. 2008; 3: 324-330
- Management of hyperkalemia in hospitalized patients.Am J Med Sci. 2014; 347: 93-100
- Effects of presentation and electrocardiogram on time to treatment of hyperkalemia.Acad Emerg Med. 2008; 15: 239-249
- The ability of physicians to predict hyperkalemia from the ECG.Ann Emerg Med. 1991; 20: 1229-1232
- Can physicians detect hyperkalemia based on the electrocardiogram?.Am J Emerg Med. 2020; 38: 105-108
- Severe hyperkalemia: can the electrocardiogram risk stratify for short-term adverse events?.West J Emerg Med. 2017; 18: 963-971
- Clinical recognition and treatment of acute potassium intoxication.Ann Intern Med. 1950; 33: 797
- Emergency treatment of hyperkalaemia.Lancet. 1964; 283: 464-467
- Calcium-related cutaneous necrosis.Surg Forum. 1976; 27: 553-555
- Calcium chloride; a reminder.Anaesthesia. 1996; 51: 93
- Lesions associated with calcium gluconate extravasation: presentation of 5 clinical cases and analysis of cases published.Ann Plast Surg. 2017; 79: 444-449
- Clinical practice guidelines: treatment of acute hyperkalaemia in adults.UK Renal Assoc. 2014; 147: 59-77
- Potassium disorders--clinical spectrum and emergency management.Resuscitation. 2006; 70: 10-25
- European resuscitation council guidelines for resuscitation 2015: Section 4. Cardiac arrest in special circumstances.Resuscitation. 2015; 95: 148-201
- Calcium chloride versus calcium gluconate: comparison of ionization and cardiovascular effects in children and dogs.Anesthesiology. 1987; 66: 465-470
- Ionization and hemodynamic effects of calcium chloride and calcium gluconate in the absence of hepatic function.Anesthesiology. 1990; 73: 62-65
- Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 8: advanced challenges in resuscitation: section 1: life-threatening electrolyte abnormalities. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation.Circulation. 2000; 102: I217-I222
- The effects of calcium and sodium bicarbonate on severe hyperkalaemia during cardiopulmonary resuscitation: a retrospective cohort study of adult in-hospital cardiac arrest.Resuscitation. 2016; 98: 105-111
- Electrocardiography is unreliable in detecting potentially lethal hyperkalaemia in haemodialysis patients.Nephrol Dial Transplant. 2002; 17: 1639-1642
- An integrated view of potassium homeostasis.N Engl J Med. 2015; 373: 60-72
- Acid-base and potassium homeostasis.Semin Nephrol. 2013; 33: 257-264
☆This is a review article and has not previously been presented.
User LicenseCreative Commons Attribution (CC BY 4.0) |
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article
- Reuse portions or extracts from the article in other works
- Sell or re-use for commercial purposes
Elsevier's open access license policy