Hyperkalemia resident survival guide

Hyperkalemia Microchapters
Home
Patient information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hyperkalemia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural history, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hyperkalemia resident survival guide On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hyperkalemia resident survival guide All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hyperkalemia resident survival guide
CDC on Hyperkalemia resident survival guide
Hyperkalemia resident survival guide in the news
Blogs on Hyperkalemia resident survival guide
Directions to Hospitals Treating Hyperkalemia
Risk calculators and risk factors for Hyperkalemia resident survival guide

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

For hyperkalemia smart algorithm click here

Definition

Hyperkalemia is 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

Life-threatening causes include conditions which result in death or permanent disability within 24 hours if left untreated.

• Acute renal failure
• Adrenal insufficiency
• Diabetic ketoacidosis
• Large IV doses of calcium chloride or calcium gluconate
• Massive hemolysis
• Metabolic acidosis
• Rapid tissue necrosis
• Rhabdomyolysis
• Tumor lysis syndrome

Common Causes

• Adrenal insufficiency
• Diabetic ketoacidosis
• Iatrogenic
• Medications: ACE inhibitors, angiotensin receptor blockers, amiloride, spironolactone, NSAIDS, ciclosporin, tacrolimus, trimethoprim, pentamidine, succinylcholine
• Pseudohyperkalemia
• Renal insufficiency
• Renal tubular acidosis type 4

Management

Shown below is an algorithm summarizing the approach to hyperkalemia.

Potassium > 5.5 mEq/L

R/O Pseudohyperkalemia Repeat potassium level

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

Assess EKG

EKG changes, e.g. loss of P waves, hyperacute T waves and widened QRS

No changes in EKG And Stable patient

Use rapidly acting transient agents, e.g Insulin, Dextrose, IV Calcium; with Ca gluconate generally preferred over Ca chloride, inhaled Beta2 agonists

Kayexalate, orally, and also can be given rectally in unconscious patients to avoid risks of aspiration

IV hydration

Stop potential causative medications

Use carefully in potential heart failure patients, consider diuresis when clinically appropriate

Consult with nephrology for resistant and severe cases of hyperkalemia may require urgent dialysis, yet rare

Do's

• Place the patient on a closely monitored bed for potential fatal arrhythmias, esp. with levels higher than 6.5.
• Repeat basic metabolic panels frequently.
• Stop the offending medications that are associated with hyperkalemia.
• Keep the patient well hydrated.
• Check levels of other electrolytes such as Magnesium and phosphorus as it may be abnormal as well.
• Consider consultation with nephrology.

Dont's

• Don't over use kayexalate, as it has been reported to cause colonic transmural necrosis.
• Don't over treat with IV bicarbonate as it can lead to rebound metabolic alkalosis.

References

Template:WikiDoc Sources