Category: Pharmacology & Therapeutics
Keywords: hyperkalemia, calcium, cardiac conduction, resting membrane potential (PubMed Search)
Posted: 9/11/2024 by Alicia Pycraft
(Emailed: 9/12/2024)
(Updated: 9/12/2024)
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The benefits of calcium treatment for hyperkalemia have historically been attributed to “membrane stabilization,” as it has been hypothesized to restore cardiac resting membrane potential. However, the true mechanism by which calcium improves cardiac function in this setting remains unclear. This has led to inconsistencies in the clinical threshold for treating hyperkalemia with calcium.
Piktel et al. recently conducted an experimental study investigating the adverse electrophysiologic effects of hyperkalemia and therapeutic effects of calcium treatment in isolated canine myocytes using ex vivo tissue and in vivo cellular techniques.
Key study findings:
Effects of hyperkalemia:
Effects of calcium treatment in the setting of hyperkalemia:
Limitation:
Bottom line: Findings of this study suggest that calcium's beneficial effects in hyperkalemia are not attributed to “membrane stabilization,” but rather to restoration of conduction velocity through L-type calcium channels and subsequent narrowing of the QRS complex. This supports calcium treatment in hyperkalemia when the ECG shows conduction slowing and QRS widening.
Piktel JS, Wan X, Kouk S, Laurita KR, wilson LD. Beneficial effect of calcium treatment for hyperkalemia is not due to “membrane stabilization” Crit Care Med. 2024; 52(00): 1-10.