Urgency of treatment of hyperkalemia varies with the severity of the potassium elevation, symptomatic versus asymptomatic and the cause of hyperkalemia. − Patients who have muscle weakness or paralysis, cardiac arrhythmias), serum potassium >6.5 mEq/L), and patients with moderate hyperkalemia (serum potassium >5.5 mEq/L) plus significant renal impairment and ongoing tissue breakdown need to be treated emergently. . patients with hyperkalemia have chronic, mild (≤5.5 mEq/L) or moderate (5.5 to 6.5 mEq/L) elevations in serum potassium due to chronic kidney disease (CKD) or the use of medications that inhibit the renin-angiotensin-aldosterone system ([RAAS] or both). Such patients do not require urgent lowering of the serum potassium.
sodium zirconium cyclosilicate is an inorganic, nonabsorbable crystalline compound that exchanges both sodium and hydrogen ions for potassium throughout its intestinal transit
Zirconium cyclosilicate is also effective for management of hyperkalemia among patients receiving maintenance hemodialysis. In the DIALYZE study, 196 patients receiving maintenance hemodialysis who had persistent predialysis hyperkalemia were randomly assigned to treatment with zirconium cyclosilicate (5 to 15 g orally on nondialysis days) or placebo for eight weeks. Treatment success, defined as a predialysis serum potassium (following the long interdialytic interval) of 4.0 to 5.0 mEq/L during the last four weeks of therapy, was more common with zirconium cyclosilicate (41 versus 1 percent)
Cation exchange resins-SPS - do not appear to be more effective in removing potassium from the body than laxative therapy. Although uncommon, cation exchange resins can produce severe side effects, particularly intestinal necrosis, which may be fatal.
