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
• Blood transfusion
• Diabetic ketoacidosis
• Potassium supplementation (oral or IV)
• Potassium rich diet
• 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

If repeated potassium level is normal, check potassium level in 24 hours

R/O Pseudohyperkalemia (Artifact, hemolysis, elevated WBC, elevated RBC, elevated platelets) Repeat potassium level

Check vital signs ABC's Order an EKG Obtain a concise history and physical exam Order BUN, creatinine, glucose, ABG

Assess EKG

Presence of EKG changes (Loss of P waves, hyperacute T waves and widened QRS)

Absence of EKG changes and Stable patient

1. Myocardial stabilization IV Ca gluconate (1-2 amps) Contraindicated in digoxin toxicity and hypercalcemia 2. Shift potassium from blood into cells Insulin (0.2 units for every gram of glucose administered) and 20%dextrose ( 2.5-5 ml/kg/h) Glucose level monitoring is needed Beta2 agonists (albuterol is given 10-20mg via nebulizer or 0.5 mg IV) 3. Lower total body potassium Cation exchange resin (kayexalate 30-90g given P.O. or P.R.) Loop diuretics (furosemide 1-2 mg/kg) Hemodialysis if refractory

Potassium > 6 mEq/L

5.5mEq/L<Potassium<6mEq/L

1. Monitor for cardiac arrhythmia Place the patient on a closely monitored bed for potential arrhythmias 2. Shift potassium from blood into cells Insulin (0.2 units for every gram of glucose administered) and 20%dextrose ( 2.5-5 ml/kg/h) Glucose level monitoring is needed Beta2 agonists (albuterol is given 10-20mg via nebulizer or 0.5 mg IV) 3. Lower total body potassium Cation exchange resin (kayexalate 30-90g given P.O. or P.R. Loop diuretics (furosemide 1-2 mg/kg) Hemodialysis if refractory

Lower total body potassium Cation exchange resin (kayexalate 30-90g given P.O. or P.R.) Loop diuretics (furosemide 1-2 mg/kg)

Stop any offending medications that is associated with hyperkalemia Stop oral or parenteral potassium Review potassium levels every 2-4 hours until stabilized Check levels of other electrolytes such as magnesium and phosphorus

References

Template:WikiDoc Sources