Potassium-Binding Agents to Treat Hyperkalemia
Sodium ...
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Potassium-Binding Agents to Treat Hyperkalemia
Sodium zirconium cyclosilicate (Lokelma):
 • Mechanism: Preferentially captures K in exchange for hydrogen and sodium
 • Dosing: Initial: 10 g TID for up to 48 hours. Maintenance: 10 g QD (adjust dose at weekly intervals in 5-g increments to obtain the desired serum K range). Usual maintenance dose: 5 g QoD to 15 g QD
 • Side Effects: Edema (mild to moderate); hypokalemia

Patiromer (Veltassa):
 • Mechanism: Exchanges calcium for K; also binds magnesium
 • Dosing: Initial: 8.4 g QD; increase dose as necessary at 1-wk intervals in increments of 8.4 g
 • Side Effects: Hypomagnesemia; hypokalemia; constipation, diarrhea, nausea, abdominal discomfort, flatulence

Sodium polystyrene sulfonate (Kayexelate):
 • Mechanism: Sodium-K exchange resin/polymer; nonspecifically binds K, magnesium, and calcium
 • Dosing: 15 g (4 level teaspoons) 1-4 times daily
 • Side Effects: Intestinal necrosis; electrolyte disturbances (including hypokalemia); nausea, vomiting, constipation, diarrhea; fluid overload in patients sensitive to high sodium intake; risk of aspiration

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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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