The chart below is from Management of severe hyperkalemia by Dr. Weisberg which Dr. Farkas recommends as the definitive review on hyperkalemia even though it is from 2008. There are a couple of things in the chart that no longer apply:
- Kayexalate doesn’t work.
- Dr. Farkas does not recommend saline for volume replacement and so I’m guessing he wouldn’t recommend hypertonic saline either.
Here’s Dr. Weisberg’s chart:
Today, I reviewed Dr. Farkas’ post Management of severe hyperkalemia in the post-Kayexalate era
March 15, 2015. Here is the summary from that post (But see the post for details on diuresis):
The following additional resources are from Dr. Farkas post above:
- Podcast by Scott Weingart about treatment of severe hyperkalemia from 2010.
- Review article by Weisberg regarding the management of severe hyperkalemia. Although this article is now seven years old, it remains one of the best reviews out there.
- Is Kayexalate effective? This has been discussed in EMLyceum, EMCrit, Precious Bodily Fluids, and Kamel 2012. There’s not much I can add to this discussion that hasn’t already been said, so if you’re interested in the Kayexalate issue please see these sources.
- Prior post on pH-guided resuscitation describes the rationale for choosing different fluids during resuscitation in order to optimize the final acid-base status.
- The effects of pH on renal handling of potassium is reviewed by Aronson 2011. This is a very detailed article with lots of information about various potassium channels.