Hyperkalemia resident survival guide
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Hyperkalemia Microchapters |
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Diagnosis |
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Treatment |
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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 (Artifact, hemolysis, elevated WBC, elevated RBC, elevated platelets) 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| 1. Myocardial stabilization IV Ca gluconate 2. Shift potassium from blood into cells Insulin and dextrose Beta2 agonists by nebulizer 3. Lower total body potassium Kayexalate Furosemide<Hemodialysis if refractory | 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||