Hyperkalaemia
Borders Intranet - Electrolyte Deficiency Lothian RefHelp Society for Endocrinology Guidance
Sodium zirconium cyclosilicate (Lokelma) is SUO for acute hyperkalaemia and SI for chronic use in patients on ACE inhibitors or angiotensin receptor blockers.
10g three times a day for up to 72 hours.
10g three times a day for up to 72 hours.
Avoid calcium polystyrene sulfonate in patients with hypercalcaemia.
Orally, 15g 3-4 times daily in water.
Rectally, 30g retained for 9 hours followed by irrigation to remove resin from colon.
Prescribing Notes:
- Calcium polystyrene sulphonate may be used to remove excess potassium in mild hyperkalaemia or in moderate hyperkalaemia when there are not ECG changes. Intravenous therapy is required in emergencies; see BNF and local guidelines for advice.
- To prevent constipation during treatment with calcium polystyrene sulfonate concurrent laxative therapy should be considered.
- Refer to local secondary care acute hyperkalaemia guidelines for more information.
History Notes
20/04/2023
East Region Formulary content agreed.
As per specialist.
As per specialist.
Prescribing Notes:
- Sodium zirconium cyclosilicate is approved by the Scottish Medicines Consortium for restricted use in patients with CKD stage 3b to 5 and/or heart failure who would otherwise need to lower or stop a renin angiotensin aldosterone system inhibitor, so that their blood potassium is kept at a normal level. Specific criteria apply and initiation is restricted to secondary care. Regular monitoring of serum potassium is required. Guidance available at EdRen.
History Notes
20/04/2023
East Region Formulary content agreed.
See prescribing notes below. Do not give calcium polystyrene sulfonate orally to neonates.
See prescribing notes.
Orally:
Over 1 month: 500mg-1g/kg daily in divided doses; maximum 60g per day.
Rectally:
Neonate: 0.5-1g/kg daily, irrigate colon to remove resin after 8-12 hours.
Child: 0.5-1g/kg daily, irrigate colon to remove resin after 8-12 hours; maximum 30g per day.
Prescribing Notes:
- Do not give calcium polystyrene sulfonate orally to neonates.
- For oral administration, calcium polystyrene sulfonate should be mixed with water (not fruit juice or squash).
- For rectal administration, calcium polystyrene sulfonate 1g should be mixed with 5ml of water or 10% glucose. The mixture should be retained in the rectum for as long as possible, then irrigated to remove resin prior to the next dose.
- Calcium polystyrene sulfonate may be used to remove excess potassium in mild hyperkalaemia or in moderate hyperkalaemia when there are not ECG changes.
- Severe hyperkalaemia calls for urgent treatment with intravenous infusion of soluble insulin with glucose. Calcium gluconate is given by slow intravenous injection to manage cardiac excitability.
History Notes
10/06/2020
Content migrated from LJF website.