Evaluating the comparative efficacy of multimodal treatment strategies for hyperkalemia management in a tertiary care hospital setting: A prospective cohort study

Hyperkalemia poses significant risks to patients due to its potential to cause life-threatening cardiac and neuromuscular complications. This study aimed to evaluate the effectiveness of different treatment protocols for hyperkalemia in hospitalized patients. This prospective observational study, conducted at Sindh Government Hospital Korangi, Karachi, included adult patients (>18 years) with potassium levels ?5.5 mEq/L. The study evaluated the effectiveness of different treatments in normalizing potassium levels, with treatment choices made at the discretion of the treating physicians. Among the 341 patients, treatment effectiveness varied by hyperkalemia severity. For mild hyperkalemia, D50W with insulin and sodium bicarbonate achieved normokalemia in 83.3% of cases, compared to 55% with Sodium-Polysorbate alone. In moderate hyperkalemia (189 patients), the combination of D50W, insulin, sodium bicarbonate, calcium gluconate and Sodium-Polysorbate reduced potassium levels from 6.52 to 6.01 mmol/L (p<0.001), with 27.2% achieving normokalemia. In severe hyperkalemia (104 patients), this regimen led to significant reductions (0.88-1.18 mmol/L, p<0.001), with 17.6% reaching normokalemia. Multi-drug approaches are advocated for effective hyperkalemia management, particularly for moderate to severe cases. Future research should focus on refining treatment protocols and improving adherence to guidelines to ensure consistent management outcomes.