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 ABC's Order an EKG Obtain a concise history and physical exam<Order BUN, creatinine, glucose, ABG | |||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| 1. Monitor for cardiac arrhythmia Place the patient on a closely monitored bed for potential arrhythmias 2. Shift potassium from blood into cells Insulin and dextrose Beta2 agonists by nebulizer 3. Lower total body potassium Kayexalate Furosemide<Hemodialysis if refractory | Kaexalate (orally, and also can be given rectally in unconscious patients to avoid risks of aspiration) Furosamide | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Stop any offending medications that are associated with hyperkalemia Order spot urine potassium, osmolality, creatinine Check levels of other electrolytes such as magnesium and phosphorus | |||||||||||||||||||||||||||||||||||||||||||||||||||