Table 1.

Pharmacology of current treatments for hyperkalaemia

	Mechanism of action	Adverse effects
SPS/CPS	Removal	Nausea, constipation, diarrhoea, paralytic ileus, cecal perforation, hypercalcaemia, hypernatraemia
	Onset: 60–180 min
	Duration: 240–360
	K+ reduction: 0.5–1.0 per 1 g resin
Haemodialysis	Removal	Hypokalaemia, arrhythmias
	Onset: <10 min
	Duration: <60–180
	K+ reduction : 1.2–1.5/h
Loop diuretic (furosemide)	Removal	Ototoxicity, hypokalaemia, nephrotoxicity
	Onset: immediate 15 min
	Duration: 120–180
Insulin + dextrose	Translocation	Hypoglycaemia, hyperosmolarity, volume overload
	Onset: <15–30 min
	Duration: 240–360
	K+ reduction: 0.5–1.5 mEq/L (dose-dependent)
Beta-adrenergic agonists	Translocation	Tremor, tachycardia
	Onset: 3–5 min onset
	Duration: 1–4 h
	K+ reduction: 1.6–1.7/2 h (salbutamol)
Sodium bicarbonate (only in patients with metabolic acidosis— bicarbonate <22 mEq/L)	Translocation (doubt effect)	Hypernatraemia, volume overload, tetany, hypertension
	Correction of acidosis
	Onset: 30–60 min (onset).
	Duration: 2–6 h
Calcium gluconate	Translocation	Hypercalcaemia, tissue necrosis
	Stabilise myocardium, protect cardiomycytes
	Onset: 1–3 min
	Duration: 30–60 min
	K+ reduction: 0.5–1.5 mEq/L

CPS, calcium polystyrene sulfonate; K⁺, potassium; SPS, sodium polystyrene sulfonate.