MANAGEMENT OF SEVERE HYPERKALEMIA: EVIDENCE-BASED STRATEGIES FOR ARRHYTHMIA PREVENTION AND MORTALITY REDUCTION

Abstract

ABSTRACT: Severe hyperkalemia is a clinical emergency associated with the risk of myocardial electrical instability, potentially fatal arrhythmias, cardiac arrest, and mortality, especially in patients with kidney disease, heart failure, diabetes mellitus, and use of medications that interfere with renal potassium excretion. This article aims to analyze, based on recent scientific evidence, the main strategies used in the management of severe hyperkalemia, with emphasis on arrhythmia prevention, sustained potassium removal, and clinical implications related to mortality. This is a narrative bibliographic review with a qualitative approach, based on studies published between 2016 and 2026, available in databases such as PubMed/MEDLINE, Cochrane Database of Systematic Reviews, SciELO, and ScienceDirect, as well as clinical guidelines and consensus documents from scientific institutions. The findings show that the management of severe hyperkalemia should be simultaneous and integrated, involving myocardial stabilization with intravenous calcium, intracellular potassium redistribution with insulin associated with glucose and beta-agonists, and effective potassium removal through diuresis, gastrointestinal binders, or renal replacement therapy. Although these strategies may contribute to better clinical outcomes, direct evidence of mortality reduction remains limited due to the predominance of observational studies, narrative reviews, and consensus-based recommendations. It is concluded that the management of severe hyperkalemia should prioritize early recognition, arrhythmia prevention, sustained potassium removal, therapeutic safety, and recurrence prevention in urgent care, emergency, and intensive care settings.