Liu Mengyang, Rafique Zubaid
Ben Taub General Hospital, Baylor College of Medicine, 1504 Ben Taub Loop, Houston, TX, 77030, USA.
Curr Heart Fail Rep. 2019 Jun;16(3):67-74. doi: 10.1007/s11897-019-00425-2.
Hyperkalemia is a common electrolyte abnormality that can lead to life-threatening cardiac arrhythmia. Medical management of acute hyperkalemia revolves around three strategies-stabilizing the myocardium, intracellular shifting of serum potassium, and enhancing elimination of total body potassium via urinary or fecal excretion. In this review, we outline the current evidence behind the acute medical management of hyperkalemia.
Two new oral potassium-binding agents, patiromer and sodium zirconium cyclosilicate, show promise in the management of hyperkalemia. Their role in the acute setting needs further investigation. Recent investigations also suggest that the optimal dosing of intravenous insulin may be lower than previously described. Despite its prevalence, there is wide variability in the medical management of hyperkalemia in the acute setting. High-quality evidence demonstrating efficacy is lacking for many medications, though novel oral potassium-binding agents show promise. Overall, more research is necessary to establish optimal dosing strategies to manage hyperkalemia in the acute setting.
高钾血症是一种常见的电解质异常，可导致危及生命的心律失常。急性高钾血症的药物治疗围绕三种策略展开——稳定心肌、使血清钾向细胞内转移以及通过尿液或粪便排泄增强机体总钾的清除。在本综述中，我们概述了急性高钾血症药物治疗背后的当前证据。
两种新型口服钾结合剂，帕替罗姆和环硅酸锆钠，在高钾血症的治疗中显示出前景。它们在急性情况下的作用需要进一步研究。最近的研究还表明，静脉注射胰岛素的最佳剂量可能低于先前描述的剂量。尽管高钾血症很常见，但在急性情况下其药物治疗存在很大差异。许多药物缺乏证明疗效的高质量证据，不过新型口服钾结合剂显示出前景。总体而言，需要更多研究来确定急性情况下治疗高钾血症的最佳给药策略。
