Hyperkalemia resident survival guide

WikiDoc Resources for Hyperkalemia resident survival guide
Articles
Most recent articles on Hyperkalemia resident survival guide Most cited articles on Hyperkalemia resident survival guide Review articles on Hyperkalemia resident survival guide Articles on Hyperkalemia resident survival guide in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Hyperkalemia resident survival guide Images of Hyperkalemia resident survival guide Photos of Hyperkalemia resident survival guide Podcasts & MP3s on Hyperkalemia resident survival guide Videos on Hyperkalemia resident survival guide
Evidence Based Medicine
Cochrane Collaboration on Hyperkalemia resident survival guide Bandolier on Hyperkalemia resident survival guide TRIP on Hyperkalemia resident survival guide
Clinical Trials
Ongoing Trials on Hyperkalemia resident survival guide at Clinical Trials.gov Trial results on Hyperkalemia resident survival guide Clinical Trials on Hyperkalemia resident survival guide at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Hyperkalemia resident survival guide NICE Guidance on Hyperkalemia resident survival guide NHS PRODIGY Guidance FDA on Hyperkalemia resident survival guide CDC on Hyperkalemia resident survival guide
Books
Books on Hyperkalemia resident survival guide
News
Hyperkalemia resident survival guide in the news Be alerted to news on Hyperkalemia resident survival guide News trends on Hyperkalemia resident survival guide
Commentary
Blogs on Hyperkalemia resident survival guide
Definitions
Definitions of Hyperkalemia resident survival guide
Patient Resources / Community
Patient resources on Hyperkalemia resident survival guide Discussion groups on Hyperkalemia resident survival guide Patient Handouts on Hyperkalemia resident survival guide Directions to Hospitals Treating Hyperkalemia resident survival guide Risk calculators and risk factors for Hyperkalemia resident survival guide
Healthcare Provider Resources
Symptoms of Hyperkalemia resident survival guide Causes & Risk Factors for Hyperkalemia resident survival guide Diagnostic studies for Hyperkalemia resident survival guide Treatment of Hyperkalemia resident survival guide
Continuing Medical Education (CME)
CME Programs on Hyperkalemia resident survival guide
International
Hyperkalemia resident survival guide en Espanol Hyperkalemia resident survival guide en Francais
Business
Hyperkalemia resident survival guide in the Marketplace Patents on Hyperkalemia resident survival guide
Experimental / Informatics
List of terms related to 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 [[Hyperkalemia smart algorithm

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

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

Management

Shown below is an algorithm summarizing the approach to hyperkalemia.

High potassium level

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, 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

• Be ware when using 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