What To Do If Blood Potassium Is Elevated? See These 6 Points For Treatment!

The intake and excretion of potassium in the body can be summed up in one sentence: eat more and row more, eat less and row less, and row without eating. Normal adults need potassium 0.4mmol/kg per day, about 3-4g, and the main source is food, which is eaten through the mouth. The normal adult blood potassium concentration is 3.5-5.5mmol/L, if it exceeds 5.5mmol/L, it is called hyperkalemia.

The kidney is the main organ of potassium excretion in the human body. The excretion of potassium in urine accounts for 85% of the total excretion of potassium in the human body, and the excretion of potassium in feces and sweat accounts for 10% and 5%, respectively. This explains why patients with chronic kidney disease (CKD) are prone to Hyperkalemia occurs. Because the main potassium excretion organ, the kidney, is dysfunctional, the potassium in the row is not excreted, and the blood potassium will naturally rise.

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 1 Common causes of hyperkalemia in CKD patients

(1) Decreased renal function and decreased potassium excretion

 For CKD patients, if the glomerular filtration rate (GFR) is >10ml/min and the daily urine output is >600ml, hyperkalemia is not prone to occur. However, if other risk factors appear at this time, such as oral and intravenous potassium supplementation, or consumption of potassium-containing foods, such as losartan potassium commonly used in nephrology, commonly used antibiotics amoxicillin clavulanate potassium, etc., and antagonism of aldosterone or renal tubular Potassium-secreting drugs are very prone to hyperkalemia. These drugs are described in detail below.

 (2) Commonly used drugs in nephrology cause

 ■ Potassium-sparing diuretics

 Spironolactone is a potassium-sparing diuretic widely used clinically. Its structure is similar to aldosterone, and it is a competitive inhibitor of aldosterone. The excretion of K+ and Mg2+ is less, and it acts as a potassium-sparing diuretic. Diuretics with similar mechanisms include triamterene and amiloride.

In CKD patients, these drugs are often used in combination with potassium-sparing diuretics such as furosemide and torasemide to reduce edema and avoid hypokalemia. It also prevents ventricular remodeling by blocking aldosterone and is often used in patients with CKD and heart failure. Due to its own potassium-sparing effect, if it is used in combination with potassium-containing drugs, food, or infusion of stored blood, or with other drugs that affect potassium excretion, it is necessary to pay attention to rechecking serum potassium, otherwise, hyperkalemia is prone to occur.

■ Angiotensin-Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARBs)

 These two types of drugs are commonly used drugs in the treatment of CKD, which can reduce proteinuria by reducing GFR. Even in CKD patients with elevated serum creatinine, as long as the indication for discontinuation is not met, it is still used clinically. However, these drugs can reduce the level of aldosterone in the human body, especially when used in combination with the above potassium-sparing diuretics, they will affect the excretion of potassium more, and special attention should be paid when using them.

■ Immunosuppressants

 Cyclosporine and tacrolimus are commonly used drugs for the treatment of kidney disease. Both can redistribute potassium by inhibiting the sodium-potassium pump in the basal membrane. The difference is that cyclosporine can also inhibit COX-2 The expression of, causes hypotension and hypoaldosteronemia, and inhibits the K+ on-off of distal nephrons, eventually leading to the occurrence of hyperkalemia.

In addition, heparin and non-steroidal anti-inflammatory drugs (NSAIDs) can also lead to elevated serum potassium through different mechanisms and should be used with caution.

 (3) Low renin and low aldosterone syndrome

Patients and the elderly with diabetes, systemic lupus erythematosus, multiple myeloma, acute glomerulonephritis, renal interstitial, and other diseases, due to the inhibition of the plasma renin-angiotensin-aldosterone system (RAAS), The response of the adrenal glomerulus to angiotensin II (Ang II) is impaired, which affects the function of the distal renal tubule to secrete potassium, and is also prone to hyperkalemia. Such patients should pay attention to the review of serum potassium.

In addition, hemolysis of the specimen and mechanical damage during venipuncture can also cause pseudo-hyperkalemia. It is recommended to exclude the above-mentioned factors that may cause hyperkalemia, and repeat blood sampling for the re-examination of serum potassium [1].

 2 How to treat hyperkalemia

The biggest threat of hyperkalemia to the body is cardiac depression, so the principle of treatment is to rapidly reduce blood potassium to protect the heart.

 (1) Use calcium:

 Because high potassium is very toxic to the myocardium, it can lead to arrhythmias, and with the increase of serum potassium, the arrhythmia gradually increases. When blood potassium is as high as 12mmol/L, a ventricular arrest may even occur, resulting in sudden death. Therefore, it is recommended to use calcium to protect the myocardium. 10% calcium gluconate or 10-20ml of 5% calcium chloride can be added to the same amount of 25% glucose injection, and it can be injected intravenously slowly, and it will take effect in a few minutes.

 (2) Reduce potassium sources:

 Immediately discontinue a high-potassium diet and drugs containing potassium or affecting potassium excretion; ensure adequate caloric supply in the body, actively control infection, and reduce potassium released by catabolism; remove necrotic tissue in the body, and do not use stored blood.

 (3) Clear blood potassium and take potassium-lowering drugs

 Potassium-scavenging diuretics: such as furosemide, hydrochlorothiazide, etc., are recommended for intravenous use. It is recommended to choose furosemide with the lowest hepatic metabolism. Combined use of thiazides can achieve better results. In the case of renal insufficiency, these drugs have poor potassium excretion effect, and attention should be paid to the maximum dose of each diuretic. The maximum dose of furosemide intravenous injection is 200 mg/d, and excessive use will not achieve greater effect. The guidelines recommend that oral potassium-lowering drugs can be used to achieve the effect of lowering blood potassium.

 (4) Promote the transfer of potassium into cells

 ■ Insulin and glucose:

 Ordinary insulin, according to the standard of 1 IU insulin per 3-4g of sugar, is put into glucose injection for continuous injection. Generally, blood potassium begins to decrease within 10-20 minutes, and continuous use for 4-6 hours can reduce blood potassium by 0.6 -1.0mmol/L, those with high blood sugar can only inject insulin, and repeat the injection if necessary. Whether the patient has diabetes or not, blood sugar monitoring is recommended to avoid hypoglycemia.

■ Sodium bicarbonate:

 In addition to promoting the entry of potassium into the cells, sodium bicarbonate can also increase the exchange of sodium and potassium ions in the distal renal tubules and promote the excretion of potassium in the urine. It is especially suitable for patients with renal insufficiency and metabolic acidosis. In addition, it can antagonize the myocardial inhibitory effect of potassium and protect the heart muscle. 100-200ml of 5% sodium bicarbonate can be used for intravenous infusion, and it can take effect in a few minutes. It cannot be mixed with calcium gluconate during use, otherwise, precipitation will occur.

■ β2-adrenoceptor agonists:

Salbutamol can also promote potassium in cells.

 (5) Cation exchange resin and sorbitol:

Commonly used is sodium polystyrene sulfonate resin. When using, clean the enema first, then place 40g of this resin in 200ml of 25% sorbitol as a retention enema, and keep it for more than 1 hour.

Oral resin, 10-20g, orally 2-3 times a day. It can be taken alone or in combination with 25% sorbitol solution orally, 20ml at a time, 2-3 times a day, and increase the dose as appropriate until the stool is thin to prevent excessive sodium absorption and induce intestinal obstruction.

The effect of this method is slow, so it cannot be quickly effective for severe acute hyperkalemia. The above-mentioned treatment methods must be used first to control the serum potassium to an appropriate level before using it as a continuous preventive measure.

(6) Dialysis:

 It is the fastest and most effective measure for lowering potassium, especially suitable for patients who have reached the uremia stage and have heart failure and metabolic acidosis and who are difficult to seek medical treatment. If the above measures are ineffective, dialysis can be used [2].

Summarize:

It is recommended that when hyperkalemia occurs, the above methods should be used in combination until the serum potassium falls to the normal range. If the above drugs are used in combination, the serum potassium cannot be reduced. It is recommended to try to reduce potassium by dialysis to protect the life safety of the patient.

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