Hyperkalemia fludrocortisone

Hyperkalemia Restrict dietary intake dialysis May be exacerbated by CSA or TAC or ACEIs, acidosis, or Rl fludrocortisone acetate 0.1 mg orally every day twice daily for refractory hyperkalemia... 

If hyperkalemia is present after the hydrocortisone maintenance phase, additional mineralocorticoid usually is required. Fludrocortisone acetate 0.1 mg orally once daily is the agent of choice. 

Hyperkalemia is an occasional complication of heparin therapy. It has been attributed to hypoaldosteronism, and fludrocortisone has been used to treat it (12). It has been suggested that marked hyperkalemia is only likely to occur in the presence of other factors that alter potassium balance (13). 

Sherman DS, Kass CL, Fish DN. Fludrocortisone for the treatment of heparin-induced hyperkalemia. Ann Pharmacother 2000 34(5) 606-10. 

The metabolic acidosis associated with hyperkalemic distal (type IV) RTA with hyporeninemic-hypoaldosteronemia that is often seen in patients with diabetes meUitus may be corrected by the treatment of hyperkalemia alone (see Chap. 50). The use of supplemental alkali (1 to 2 mEq/kg per day) to increase sodium intake and stimulate distal tubular potassium secretion may be beneficial. A minority of patients require the administration of pharmacologic amounts of fludrocortisone." Type TV RTA resulting from a generalized distal tubular disorder often responds to low doses of alkali (1.5 to 2.0 mEq/kg per day). ° Corrections of the acidosis along with modest dietary potassium restriction (to 1 mEq/kg per day) wfll often result in the maintenance of serum potassium levels of 5 mEq/L or less. 

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