Case 1

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2005 / 09 / 15
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Hyperkalemia
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Hyperkalemia

• Symptoms
• Generalized fatigue
• Weakness
• Paresthesias
• Paralysis
• Palpitations

Nonspecific!
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Hyperkalemia
??!

• Etiology
• Acute or chronic renal failure
• Crush injuries (rhabdomyolysis), burns
• Foods (eg, bananas, oranges, high-protein diets,
  tomatoes, salt substitutes)
• Redistribution Acidosis, insulin deficiency,
  beta-blocker, acute digoxin overdose,
  succinylcholine, periodic paralysis (PP)
• Drugs slow-K, spirinolactone diuretics, NSAIDs

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Hyperkalemia

• Mild 5.5-6.5 mEq/L
• peaked T waves
• Moderate 6.5-7.5 mEq/L
• prolonged PR interval
• decreased P wave
• ST depression or elevation
• slight widening of the QRS

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Hyperkalemia (cont.)

• Severe 7.5-8.5 mEq/L
• wide QRS
• flat and wide P waves
• VPCs
• Life-threatening gt8.5 mEq/L
• loss of P
• AV blocks
• VT / VF
• sinusoid patern

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(No Transcript)
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Hyperkalemia

• Specific management "See BIG Potassium Drop"
• Calcium
• Bicarbonate
• Insulin and Glucose
• Kayexalate
• Dialysis

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Hyperkalemia

• General management
• Continuous ECG monitoring
• DC K-sparing drugs (ACEI, spirinolactone)
• DC high-K foods

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Calcium

• Stabilize cell membrane
• Calcium gluconate 10, 10 ml over 2-5 min
• 2nd dose after 5 min if no response
• Effect occurs in minutes and lasts for 1 hour
• Further calcium ineffective unless hypocalcemia
  exists
• Digoxin Toxicity ? contraindication !

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Bicarbonate

• Shift K to intracellular
• 3 amp Jusomine IV over 5 min
• May repeat q10-15 min
• Onset in 30 min duration 1-2 hours
• Avoid bicarbonate if
• Hypocalcemia
• Severe lung edema

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Glucose and Insulin

• Redistribution
• RI 10U D50GW 50cc over 5 min
• Consider Albuterol Neb as adjunct
• Onset 50-60 min duration several hours
• Follow F/S

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Potassium Removal

• Cation-Exchange resin (Kayexalate)
• 15-30 gm PO q3-4 hrs or 50 gm in 200 ml retention
  enema for 30-60 min q4hr
• Dialysis May experience significant hyperkalemia
  on rebound

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Summary

• Hyperkalemia
• Symptoms?
• Diagnosis?
• EKG?
• Etiology?
• Treatment?

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