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Management of severe hyperkalemia

Section Editor(s): Dellinger, R.Phillip MD,FCCMWeisberg, Lawrence S. MD

doi: 10.1097/CCM.0b013e31818f222b
Concise Definitive Review

Background and Objectives: Hyperkalemia is one of the few potentially lethal electrolyte disturbances. Prompt recognition and expeditious treatment of severe hyperkalemia are expected to save lives. This review is intended to provide intensivists and other interested clinicians with an understanding of the pathophysiology that underlies hyperkalemia, and a rational approach to its management.

Methods: This article reviews and analyzes literature relevant to the pathophysiology and management of severe hyperkalemia. Methods include search of MEDLINE, and bibliographic search of current textbooks and journal articles.

Results and Conclusions: A more complete understanding of potassium homeostasis in recent years has led to new approaches to the management of severe hyperkalemia. The physiologically based sequential approach still applies. The efficacy, pitfalls, and risks of the agents available for use at each step in the sequence are critically reviewed. Rational use of the available tools will allow clinicians to successfully treat severe hyperkalemia.

From the Division of Nephrology, Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, Cooper University Hospital, Camden, NJ.

The author has not disclosed any potential conflicts of interest.

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© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins