K wars

Dr Joel Topf has posted a video of a lecture he prepared on the latest therapies for hyperkalemia. It is an hour and 17 minutes long but reviews the dangers of kayexalate and how little it was studied before it's introduction in the 1960's. I cringe whenever an ICU nurse tells me they have given kayexalate before I arrive and it's current use is being challenged. Colonic necrosis is the major risk.

Other drugs seeking to replace sodium polystyrene sulfonate are Patiromer and ZS-9 (zirconium silcate). Dr Topf also discusses do we really need to be agressively treating hyperkalemia and at what level does high potassium equal increased mortality. His point is that many cases of hyperkalemia can be solved by 4 measures:

1.stopping the poison

ace inhibitors

ace blockers

aldosterone agonists

2. placing a foley

3. correcting the glucose

4. giving a bag of saline