Hyperkalemia resident survival guide: Difference between revisions
Jump to navigation
Jump to search
Rim Halaby (talk | contribs) |
Rim Halaby (talk | contribs) No edit summary |
||
| Line 39: | Line 39: | ||
{{familytree | | | | | | | | | A01 | | | | | |A01=R/O Pseudohyperkalemia<br>Repeat potassium level}} | {{familytree | | | | | | | | | A01 | | | | | |A01=R/O Pseudohyperkalemia<br>Repeat potassium level}} | ||
{{familytree | | | | | | | | | |!| | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | }} | ||
{{familytree | | | | | | | | | A02 | | | | | |A02=Check [[vital signs]]<br>Stabilize the patient<br>Order an [[EKG]]<br> | {{familytree | | | | | | | | | A02 | | | | | |A02=Check [[vital signs]]<br>Stabilize the patient<br>Order an [[EKG]]<br>Obtain a concise history and physical exam}} | ||
{{familytree | | | | | | | | | |!| | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | }} | ||
{{familytree | | | | | | | | | B01 | | | | | |B01=Assess [[EKG]]}} | {{familytree | | | | | | | | | B01 | | | | | |B01=Assess [[EKG]]}} | ||
| Line 49: | Line 49: | ||
{{familytree | | | |:| | | | | | E01 | | | | | | | | | E02 |E01=Potassium > 6|E02= 5.5mEq/L < Potassium < 6 mEq/L}} | {{familytree | | | |:| | | | | | E01 | | | | | | | | | E02 |E01=Potassium > 6|E02= 5.5mEq/L < Potassium < 6 mEq/L}} | ||
{{familytree | | | |:| | | | | | |!| | | | | | | | | | |!| | | | }} | {{familytree | | | |:| | | | | | |!| | | | | | | | | | |!| | | | }} | ||
{{familytree | | | |:| | | | | | F01 | | | | | | | | | F02 | |F01=Rapidly acting transient agents: [[Insulin]] and [[glucose]]<br>[[Beta2-adrenergic receptor agonist|Beta2 agonists]] by nebulizer|F02=Kaexalate (orally, and also can be given rectally in unconscious patients to avoid risks of [[aspiration]])<br>Furosamide}} | {{familytree | | | |:| | | | | | F01 | | | | | | | | | F02 | |F01=Rapidly acting transient agents: [[Insulin]] and [[glucose]]<br>[[Beta2-adrenergic receptor agonist|Beta2 agonists]] by nebulizer<br><br>Place the patient on a closely monitored bed for potential arrhythmias|F02=Kaexalate (orally, and also can be given rectally in unconscious patients to avoid risks of [[aspiration]])<br>Furosamide}} | ||
{{familytree | | | |:| | | | | | |:| | | | | | | | | | |:| | | | }} | {{familytree | | | |:| | | | | | |:| | | | | | | | | | |:| | | | }} | ||
{{familytree | | | |L|~|~|~|~|~|~|%|~|~|~|~|~|~|~|~|~|~|J| | | | }} | {{familytree | | | |L|~|~|~|~|~|~|%|~|~|~|~|~|~|~|~|~|~|J| | | | }} | ||
{{familytree | | | | | | | | | | G01 | | | | | | | | | | | | | |G01=Stop the offending medications that are associated with [[hyperkalemia]]<br>Order spot urine potassium, osmolality, creatinine}} | {{familytree | | | | | | | | | | G01 | | | | | | | | | | | | | |G01=Stop the offending medications that are associated with [[hyperkalemia]]<br><br>Order spot urine potassium, osmolality, creatinine<br><br>Check levels of other [[electrolyte|electrolytes]] such as [[magnesium]] and [[phosphorus]] as it may be abnormal as well}} | ||
{{familytree/end}} | {{familytree/end}} | ||
==References== | ==References== | ||
Revision as of 17:27, 27 July 2013
|
Hyperkalemia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Hyperkalemia resident survival guide On the Web |
|
American Roentgen Ray Society Images of Hyperkalemia resident survival guide |
|
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 Obtain a concise history and physical exam | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Assess EKG | |||||||||||||||||||||||||||||||||||||||||||||||||||
EKG changes, e.g. loss of P waves, hyperacute T waves and widened QRS | |||||||||||||||||||||||||||||||||||||||||||||||||||
| IV Ca gluconate Rapidly acting transient agents: Insulin and glucose Beta2 agonists by nebulizer | No changes in EKG And Stable patient | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Potassium > 6 | 5.5mEq/L < Potassium < 6 mEq/L | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Rapidly acting transient agents: Insulin and glucose Beta2 agonists by nebulizer Place the patient on a closely monitored bed for potential arrhythmias | Kaexalate (orally, and also can be given rectally in unconscious patients to avoid risks of aspiration) Furosamide | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Stop the offending medications that are associated with hyperkalemia Order spot urine potassium, osmolality, creatinine Check levels of other electrolytes such as magnesium and phosphorus as it may be abnormal as well | |||||||||||||||||||||||||||||||||||||||||||||||||||