Podcast 759: Hyperkalemia and Myth of Kayexalate

Contributor: Nick Tsipis, MD

Educational Pearls:

• Acute hyperkalemia is characterized as serum K of 5.4 or higher in non-hemolyzed samples
• Hyperkalemia is commonly associated with end stage renal disease, acute kidney injury or acute renal failure
• Cardiac dysrhythmias are the primary concern with hyperkalemia, common EKG changes (and approximate serum levels) can include:
• • Peaked T waves that start to show at serum K of 6
  • Second sign is lengthening of PR and QRS intervals due to extended repolarization
  • Severe hyperkalemia manifests as a sine wave around serum of 8-9

• Three approaches to treat hyperkalemia:
• • Stabilize cardiac membrane with calcium
  • Shift potassium back into the cell, insulin and albuterol are common agents used.
  • Potassium binding for excretion
• Cochrane review showed no significant effects of Kayexalate on serum K in 4 hours
• Bowel necrosis is a rare adverse event that can occur with Kayexalate
• More myths and misconceptions about hyperkalemia addressed in reference below!

References:

Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. Am J Emerg Med. 2022;52:85-91. doi:10.1016/j.ajem.2021.11.030

Mahoney BA, Smith WA, Lo DS, Tsoi K, Tonelli M, Clase CM. Emergency interventions for hyperkalaemia. Cochrane Database Syst Rev. 2005;2005(2):CD003235. Published 2005 Apr 18. doi:10.1002/14651858.CD003235.pub2

Li T, Vijayan A. Insulin for the treatment of hyperkalemia: a double-edged sword?. Clin Kidney J. 2014;7(3):239-241. doi:10.1093/ckj/sfu049

Summarized by Mason Tuttle| Edited by Nick Tsipis, MD