Hyperkalemia Management in Skilled Nursing Facilities

Dietary Management and Medication Adjustment

Implement dietary potassium restriction, collaborating with a dietitian to provide low-potassium meal options and educating staff and family about dietary restrictions, as recommended by the American Heart Association 1, 2, 3
Review and adjust medications that may contribute to hyperkalemia, considering temporary adjustment of ACE inhibitors, ARBs, potassium-sparing diuretics, or potassium supplements, according to the American College of Cardiology 2

Monitor serum potassium, renal function, and other electrolytes regularly during treatment, checking levels every 2-4 hours initially for severe hyperkalemia and daily until normalized for moderate hyperkalemia, as suggested by the American Heart Association 2
Implement regular monitoring of potassium levels in high-risk patients, such as those with kidney disease, heart failure, or on medications affecting potassium, as recommended by the American College of Cardiology 2
Establish protocols for diuretic dosage adjustment to maintain euvolemia while minimizing electrolyte disturbances, according to the American Heart Association 2, 4
Consider chart audit and feedback systems to improve hyperkalemia management in the SNF setting, as proposed by the American Heart Association 6

Implement careful surveillance for common causes of hyperkalemia in SNF residents, including infections, dehydration, and medication effects, as recommended by the American College of Cardiology 2, 4
Establish clear protocols for when to transfer patients to acute care facilities if hyperkalemia cannot be adequately managed in the SNF, although the guideline from Praxis Medical Insights is not prioritized 5