Quote from Mikai on October 4, 2025, 2:12 pm

Management of hyperkalemia in ESRD patient

**Dietary modifications** - Restrict potassium intake (2–3 g/day) - Avoid potassium-rich foods (bananas, oranges, potatoes, tomatoes) - Avoid salt substitutes containing potassium -

 

**Medications** -

    **Kaliuretic diuretics** (e.g., furosemide, bumetanide) to promote potassium excretion -   **RAS inhibitors** (e.g., ACE inhibitors, ARBs) should be used cautiously or discontinued if hyperkalemia persists -    **Potassium binders** (e.g., patiromer, sodium zirconium cyclosilicate) to reduce potassium levels -

 

**Dialysis** - Regular dialysis sessions to remove excess potassium - Consider more frequent or longer dialysis if hyperkalemia is severe or refractory -

 

**Acute management (if severe hyperkalemia)** -

  **Calcium gluconate** (10% solution, 10–20 mL IV) for cardiac protection - *

   *Insulin + glucose** (e.g., 10 U regular insulin + 50 mL D50W) to shift potassium intracellularly - *

   *Albuterol** (nebulized, 10–20 mg) to promote potassium shift - *

   *Sodium bicarbonate** (if acidosis present) to correct pH and shift potassium -

 

**Monitoring** - Frequent potassium level checks (especially post-intervention) - Assess for ECG changes (peaked T waves, widened QRS, etc.) - *

 

 

*Rationale:** - ESRD patients often have impaired renal excretion, so dietary and medication adjustments are critical. - Dialysis remains the most effective long-term management for hyperkalemia in ESRD.