HYPERKALEMIA

 

Etiology:

  1. Renal Failure, Acidosis, Cell lysis (burn, chemotherapy), Potassium sparing meds, steroids., b-blockers, Insulin deficiency, Thrombo/Leukocytosis, ACE-i, Tubular unresponsiveness (SLE, MM, SC anemia)

S & S : 

  1. Neurologic (weakness, reflexes, paresthesias) and  Cardiac (PVC's, bradycardia, asystole).

DX : 

  1. K+ = 5.6-6.0 on EKG  T wave in precordial leads
  2. K+ = 6.0-6.5 on EKG >PR and >QT
  3. K+ = 6.5- 7.0 on EKG  flattening of P wave
  4. K+ >7.5 on EKG BBB pattern, >QRS
  5. K+ >10 on EKG sine wave (looks almost as if it was A-line registration wave) 

NOTE!!! This  classification doesn't apply  to pts who are used to hyperkalemic state such as "renal" pts and not infrequently pt will have only  high T wave  corresponding to K of 6.0, yet  the lab report may be higher. Death occurs in diastole.

Treatment:

  1. K+ level <6.0  -produce diuresis.
     
  2. K+ level >6.0 - give kayexalate 20-30gm. This binds K+ and it works when pt has bowel movement. Each gram binds 1mEq of K, but high Na concentration may give volume overload.
     
  3. K+ level >6.5 - give RI 10 U + D 50 Glucose. This works by redistribution. Onset of action is in 1/2hr. Action duration 3hrs
     
  4. K+ level 6.5-7.0 -add NaHCO3 50-100mEq over 5 min. Works by redistribution and antagonism. Onset of action in 10min. Action duration 1-2hrs.
     
  5. K+ level >7.0-7.5 give the following sequence: CaCl (or Ca Gluconate)
    - NaHCO - D50+RI 10 U. CaCl ( or CaGluconate) give 10-20ml over 5 min.
    Works by antagonism. Onset of action 1-3min. Duration of action ½ hr.
    CaGluconate contains 5mEq of Ca per ampule while CaCl - 13.5mEq
    per ampule. Also Ca is faster available from Chloride form. If hyperK
    is associated with DIG toxicity Ca is not recommended. Note! The sequence
    is: CaCl-NaHCO3-D50+RI+diuresis
     
  6. Patient that is dialysis dependent, adding Albuterol  (Ventolin, Proventil )
    via neb (in addition to above described treatment modalities), was  shown
    to  lower the K level.
     
  7. Hemodialysis, especially if RF.

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