1.

Non-pharmacological Treatment Options:

1.1 Dietary Modifications:
- Restricting high-potassium foods such as bananas, oranges, tomatoes,
potatoes, and certain meats.
- Reducing potassium intake to less than 2,000-3,000 mg per day.
- Foods low in potassium can be consumed instead, including most
breads, cereals, pasta, rice, and certain fruits and vegetables (such as
apples, grapes, green beans, and lettuce).
- Consultation with a registered dietitian may be beneficial for
personalized dietary guidance.

2. Pharmacological Treatment Options:

2.1 Calcium Gluconate:
- Intravenous (IV) administration of 10% calcium gluconate at a dose of 10
mL (1 gram) over 2-5 minutes.
- Mechanism of action involves stabilization of the cardiac membrane,
reducing the risk of arrhythmias associated with hyperkalemia.
- Temporary effect; often used as a bridge therapy while addressing the
underlying cause of hyperkalemia.
- Monitoring for signs of hypercalcemia, such as nausea, vomiting,
confusion, or cardiac arrhythmias, is essential.

2.2 Sodium Bicarbonate:

- Intravenous administration of sodium bicarbonate (NaHCO3) as a 50-100
mEq bolus (depending on acid-base status) over 5-10 minutes.
- Bicarbonate ions temporarily shift potassium from the extracellular fluid
into the cells.
- Significant caution is required in patients with fluid overload, impaired
renal function, metabolic alkalosis, or severe respiratory acidosis.

2.3 Insulin and Glucose:

- Intravenous administration of 10 units of regular insulin with 25 grams of
glucose over 30-60 minutes.
- Insulin promotes the movement of potassium from the blood into the
cells, while glucose prevents hypoglycemia.
- Monitoring blood glucose levels is crucial to prevent both hyper- and
hypoglycemia.
- Caution in patients with diabetes or impaired glucose tolerance.
3. Invasive Treatment Options:
3.1 Hemodialysis:
- Highly effective method for rapidly removing excess potassium from the
bloodstream.
- Indicated in severe or refractory hyperkalemia, or when renal function is
significantly compromised.
- Usually requires the presence of a functioning dialysis access site such
as an arteriovenous fistula or central venous catheter.
- The duration and frequency of hemodialysis sessions depend on the
individual patient's needs and the guidance of a nephrologist.

3.2 Peritoneal Dialysis:

- Utilizes the peritoneum as a membrane to remove waste products,
including excess potassium, from the blood.
- Performed through a catheter placed in the abdomen.
- Slower than hemodialysis but can be an option for patients who cannot
undergo hemodialysis or require long-term management.

3.3 Exchange Resins:

- Medications such as sodium polystyrene sulfonate (SPS, commonly
known as Kayexalate) bind to potassium in the gastrointestinal tract,
facilitating its elimination through stool.
- Administered orally or rectally along with a cathartic such as sorbitol.
- Dose: 15-60 grams of SPS orally or via rectal enema, followed by 20-30
grams of sorbitol.
- Close monitoring for potential complications such as intestinal necrosis
or electrolyte imbalances is necessary, especially in patients with
impaired bowel function or those receiving concomitant laxatives.