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. 2021 Oct 1;2(5):e12572.
doi: 10.1002/emp2.12572. eCollection 2021 Oct.

Hyperkalemia management in the emergency department: An expert panel consensus

Zubaid Rafique  1 , Frank Peacock  1 , Terra Armstead  2 , Jason J Bischof  3 , Joanna Hudson  4 , Matthew R Weir  5 , James Neuenschwander  3   6
Affiliations

Hyperkalemia management in the emergency department: An expert panel consensus

Zubaid Rafique et al. J Am Coll Emerg Physicians Open. .

Abstract

Hyperkalemia is a common electrolyte abnormality identified in the emergency department (ED) and potentially fatal. However, there is no consensus over the potassium threshold that warrants intervention or its treatment algorithm. Commonly used medications are at best temporizing measures, and the roles of binders are unclear in the emergent setting. As the prevalence of comorbid conditions altering potassium homeostasis rises, hyperkalemia becomes more common, and hence there is a need to standardize management. A panel was assembled to synthesize the available evidence and identify gaps in knowledge in hyperkalemia treatment in the ED. The panel was composed of 7 medical practitioners, including 5 physicians, a nurse, and a clinical pharmacist with collective expertise in the areas of emergency medicine, nephrology, and hospital medicine. This panel was sponsored by the American College of Emergency Physicians with a goal to create a consensus document for managing acute hyperkalemia. The panel evaluated the evidence on calcium for myocyte stabilization and potassium shifting and excretion. This article summarizes information on available therapies for hyperkalemia and proposes a hyperkalemia treatment algorithm for the ED practitioner based on the currently available literature and highlights diagnostic pitfalls and evidence gaps.

Keywords: acute management; algorithm; consensus recommendation; hyperkalemia.

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Conflict of interest statement

This manuscript is a consensus document of an expert panel on hyperkalemia management, sponsored by the American College of Emergency Physicians. ZR is a principal investigator for Relypsa Inc and a consultant to Relypsa Inc and AstraZeneca. FP has received consulting fees from AstraZeneca and Relypsa and grants to his institution from AstraZeneca and Relypsa. TA has nothing to disclose. JB reports personal fees from American College of Emergency Physicians, during the conduct of the study; grants from Beckman Coulter, grants from Comprehensive Research Associates, outside the submitted work; JD reports: I have presented continuing education sessions within the last year on the topic of hyperkalemia supported by educational grants from AstraZeneca. These programs were coordinated through WebMD. MW reports personal fees from Vifor, personal fees from AstraZeneca, personal fees from Boehringer‐Ingelheim, personal fees from Bayer, personal fees from Janssen, during the conduct of the study; JN reports a grant for his institution from Relypsa and consulting fees and honoraria from AstraZeneca.

Figures

FIGURE 1
FIGURE 1
Acute management algorithm for hyperkalemia. Adapted from Rafique Z, et al. Current treatment and unmet needs of hyperkalemia in the emergency department. Eur Heart J Suppl. 2019;21(Suppl A):A12‐A19. Abbreviations: CHF, congestive heart failure; CKD, chronic kidney disease; Cr, creatinine; dc, discharge; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; GI, gastrointestinal; HK, hyperkalemia; IV, intravenous; K, potassium; POC, point of care; SPS, sodium polystyrene sulfonate
See this image and copyright information in PMC

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