Hyperkalemia resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; associate editor-in-chief: Mahmoud Sakr, M.D. [2]

Definition

Hyperkalemia is best defined as a serum potassium concentration greater than 5.5 mEq/L in adults; levels higher than 7 mEq/L can lead to significant hemodynamic compromise

Causes

Life-Threatening Causes

Immediate life-threatening causes are conditions which result in immediate death or disability if left untreated.

• Acute Renal Failure
• Rhabdomyolysis
• Rapid tissue necrosis
• Tumor Lysis syndrome
• Metabolic acidosis, diabetic ketoacidosis
• Massive hemolysis
• large IV doses of Calcium chloride or calcium gluconate
• Adrenal insufficiency

Common Causes

• Pseudoyperkalemia
• Renal insufficiency
• Adrenal insufficiency
• Medications; ACE inhibitors, Angiotensin receptor blockers, amiloride,spironolactone, NSAIDS, ciclosporin, Tacrolimus, Trimethoprim, Pentamidine
• Renal tubular acidosis
• Iatrogenic

Management

Please find below an algorithm that summarizes the approach to hyperkalemia

Check vital signs Stabilize the patient Order an EKG Concise history and physical exam

Assess EKG

EKG changes;e.g. hyperacute T waves, widened QRS,

EKG not changed

order Kayexalate

STEMI Revascularization

NSTEMI Risk stratification

Pneumothorax

Aortic dissection

No significant findings on CXR

Control BP Obtain a CT scan Emergent surgery consult

Assess the pretest probability forpulmonary embolism

References

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