Hyperkalemia resident survival guide: Difference between revisions
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*[[Renal insufficiency|Acute or chronic renal failure]], (more common in acute) | *[[Renal insufficiency|Acute or chronic renal failure]], (more common in acute) | ||
*[[Adrenal insufficiency]] | *[[Adrenal insufficiency]] | ||
* Medications; [[ACE inhibitor|ACE inhibitors]], [[angiotensin II receptor antagonist|angiotensin receptor blockers]], [[amiloride]],[[spironolactone]],[[NSAIDS]],[[ciclosporin]], [[tacrolimus]], [[trimethoprim]], [[pentamidine]], [[succinylcholine]] | * Medications; [[ACE inhibitor|ACE inhibitors]], [[angiotensin II receptor antagonist|angiotensin receptor blockers]], [[amiloride]], [[spironolactone]], [[NSAIDS]], [[ciclosporin]], [[tacrolimus]], [[trimethoprim]], [[pentamidine]], [[succinylcholine]] | ||
*[[RTA|Renal tubular acidosis]] (usually with type 4) | *[[RTA|Renal tubular acidosis]] (usually with type 4) | ||
* [[Iatrogenic]] | *[[Iatrogenic]] | ||
*[[Diabetic ketoacidosis]] | *[[Diabetic ketoacidosis]] | ||
Revision as of 20:26, 23 July 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate editor-in-chief: Mahmoud Sakr, M.D. [2]
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
- Hyperkalemia is most commonly caused by increased intake, impaired renal excretion, or rapid transcellular shift.
Life-Threatening Causes
Life-threatening here means a condition that can lead to death or permanent disability within 24 hours.
- 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 (consider rechecking the levels to confirm).
- Acute or chronic renal failure, (more common in acute)
- Adrenal insufficiency
- Medications; ACE inhibitors, angiotensin receptor blockers, amiloride, spironolactone, NSAIDS, ciclosporin, tacrolimus, trimethoprim, pentamidine, succinylcholine
- Renal tubular acidosis (usually with type 4)
- Iatrogenic
- Diabetic ketoacidosis
Management
Shown below is an algorithm summarizing 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 and widened QRS | No changes in EKG, 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 and Don'ts
- Place the patient on a closely monitored bed for potential fatal arrhythmias, esp. with levels higher than 6.5.
- Repeat basic metabolic panels frequently.
- Be ware when using kayexalate, as it has been reported to cause colonic transmural necrosis.[1]
- Remove 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.
- Avoid over treating with IV bicarbonate as it may lead to rebound metabolic alkalosis.
- Consider consultation with nephrology.
References
- ↑ Lillemoe KD, Romolo JL, Hamilton SR, Pennington LR, Burdick JF, Williams GM (1987). "Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis". Surgery. 101 (3): 267–72. PMID 3824154.