Hyperkalemia — Heparin And

| Intervention | Action | |--------------|--------| | (if possible) | Switch to direct oral anticoagulant (DOAC), fondaparinux (minimal risk), or warfarin (with bridging if needed). | | IV calcium | Calcium gluconate (10% solution, 10 mL IV over 10 min) to stabilize myocardium if ECG changes present. | | Shift K⁺ intracellularly | Insulin + dextrose (e.g., 10 units regular insulin + 50 mL D50W IV). Beta-agonist (nebulized albuterol 10–20 mg). | | Enhance K⁺ elimination | Loop diuretic (furosemide 40–80 mg IV) if volume replete. Patromer or sodium zirconium cyclosilicate (SZC) for binding. Hemodialysis if severe + kidney failure. |

Heparin-Induced Hyperkalemia: Mechanisms, Risk Factors, and Clinical Implications heparin and hyperkalemia

| Patient Factor | Clinical Scenario | |----------------|-------------------| | | CKD (especially stages 4–5) | | Diabetes mellitus | Hyporeninemic hypoaldosteronism | | Older age (>60 years) | Age-related decline in renin/aldosterone | | Use of other potassium-elevating drugs | ACEi, ARB, K+-sparing diuretics (spironolactone, eplerenone, amiloride), NSAIDs, beta-blockers, trimethoprim, calcineurin inhibitors | | High heparin doses | Therapeutic anticoagulation > prophylactic doses | | LMWH use | Less common than UFH, but still reported | | Intervention | Action | |--------------|--------| | (if