Management of Hyperkalemia: Exchange Resin (Lokelma) versus Glucose insulin: Comparative Study

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Background: Acute hyperkalemia is a potentially life-threatening electrolyte disturbance requiring rapid and effective management. Intravenous insulin–dextrose therapy promotes intracellular potassium redistribution with a rapid onset but a transient effect and risk of hypoglycemia. Sodium zirconium cyclosilicate (SZC) is an oral potassium-binding agent that enhances gastrointestinal potassium elimination and may provide sustained reduction. Aim: To compare the short-term efficacy and safety of intravenous insulin–dextrose therapy versus sodium zirconium cyclosilicate in adults presenting with acute hyperkalemia. Methods: This prospective, randomized, open-label, parallel-group clinical trial enrolled 50 adults with serum potassium ≥5.5 mmol/L presenting to the Emergency and Critical Care Departments of Al-Azhar University Hospitals. Participants were allocated in a 1:1 ratio using computer-generated randomization to receive either intravenous insulin–dextrose or oral SZC 10 g. Serial serum potassium and electrocardiographic parameters were recorded at baseline, 2, 4, 6, and 12 hours. The primary endpoint was the change in serum potassium from baseline to 6 hours. Repeated-measures analysis of variance with baseline adjustment was used for longitudinal comparisons. Results: Insulin–dextrose achieved greater early potassium reduction at 2 hours, whereas SZC demonstrated sustained reduction at later time points. Hypoglycemia occurred more frequently in the insulin group. Confidence intervals for treatment differences overlapped at several time points, reflecting limited power. Conclusion: Insulin–dextrose provides rapid potassium lowering, while SZC contributes to sustained reduction over several hours. Given the modest sample size and open-label design, findings should be interpreted as exploratory.