Debunking the myths of acute hyperkalemia treatment

Abstract

The article provides an overview of the world data on modern approaches to the treatment of patients with hyperkalemia according to the principles of evidence-based medicine. Hyperkalemia is a common and potentially fatal condition that affects millions of people throughout their lives. Despite the prevalence and severity of this condition, there are no consensus recommendations for the treatment of hyperkalemia. The authors noted that a standard approach would likely improve outcomes. Further complicating the situation is that there is not even a universal definition of hyperkalemia. Historically, approaches to the treatment of acute hyperkalemia have been based on three concepts: «stabilization» of the cardiac depolarization threshold, intracellular displacement of serum potassium, and elimination of total potassium in the body. The urgency of these actions is often determined by ECG findings, as life-threatening dysrhythmias can occur over a wide range of serum potassium concentrations. Because of the difficult nature of prospectively assessing a life-threatening condition, many of these ideas have been entrenched for generations despite a lack of evidence to support them. Objective. To review information sources devoted to modern approaches to the management of patients with acute hyperkalemia, modern diagnostics, modern treatment protocols in order to establish optimal methods of treatment of patients, prevention of complications and early recovery and development of recommendations in Ukrainian. The article provides a brief overview of the most significant errors encountered in emergency care in hyperkalemia, reviews the currently available literature and discusses the practical aspects of several methods of hyperkalemia treatment. Misconceptions and disagreements about its treatment have led to controversial treatment strategies. The article reviews four of the most common myths and provides recommendations based on the interpretation of the available data. At the end of each section, recommendations from open sources are provided to help emergency physicians, internists, nephrologists, and anesthesiologists make safe and effective choices in the treatment of acute hyperkalemia. Conclusion. Hyperkalemia is a common and potentially life-threatening electrolyte disorder. Misconceptions and disagreements about its treatment have led to controversial treatment strategies. This article reviews four of the most common myths and provides recommendations based on the interpretation of the available evidence. We recommend that clinicians continue to evaluate the available evidence and make treatment decisions based on the balance between the potential benefits and harms of each of these interventions.