C L I P S Hyperkalemia SignsSymptoms Muscle

C. L. I. P. S. Hyperkalemia Signs/Symptoms: ü Muscle weakness, paresthesia, areflexia, paralysis ü Palpitations, cardiac arrhythmia ü Death Main Causes for Hyperkalemia 1. Increased Potassium Release from Cells ü Pseudohyperkalemia (check the lab comments link!) ü Metabolic Acidosis ü Insulin deficiency ü Tissue Breakdown ü Beta Blockers (think treatment with B agonists!) ü Hyperkalemic Periodic Paralysis 2. Reduced Excretion ü Reduced aldosterone secretion ü Reduced response to aldosterone ü Reduced distal Na and water delivery ü Kidney disease Common medications causing hyperkalemia? ü ACE-inhibitors, ARBs ü Spironolactone ü Bactrim ü Pentamidine ü Calcineurin inhibitors (tacrolimus) ü Beta-blockers A few diseases associated with hyperkalemia: ü AKI, ESRD ü Metabolic Acidosis and DKA ü Hypoaldosteronism (medication induced or otherwise) ü RTA (associated with sickle cell, amyloidosis and SLE) Updated 3/2020: Erik, Orli, Andres, Stacy

C. L. I. P. S. Hyperkalemia (2) Ask yourself? 1. What’s the potassium level and is it real? (>6. 5 is considered severe) 2. Does the patient have symptoms? 3. Is there a conduction abnormality? 4. Do they have renal impairment/ongoing tissue breakdown? (we may use a lower K threshold 5. 5) Work-up: ü EKG (peaked T waves, ↑PR interval, ↑QRS width, loss of P wave, sine wave pattern, PEA/Vfib) ü Chemistry ü Rule out pseudo-hyperkalemia and iatrogenic causes (e. g. hemolysis & IVF w/ K+) Treatment: Step 1: Stabilize – (if concerns for conduction issues or severe hyperkalemia) ü IV calcium gluconate, 1000 mg over 10 min Step 2: Temporize ü Regular Insulin 10 U IV and D 50 25 gm IV ü Sodium bicarbonate (esp. if acidotic), 1 -2 amps IV ü β-Agonists, albuterol 10 -20 mg inhalation (mostly adjunctive) Step 3: Excrete ü Furosemide, ≥ 40 mg IV ü Kayexalate, 15 -30 g PO/PR ü Dialysis - if needed Fun Fact: 10 units of regular insulin can drop serum K+ by 0. 5 -1. 2 m. Eq The power plan for hyper. K is nice for ease of practice and keeps patients safe! Search: “Adult Hyperkalemia Treatment”