Hyperkalemia Hyperkalemia n Symptoms Generalized fatigue Weakness Paresthesias

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常考！ Hyperkalemia

常考！ Hyperkalemia

Hyperkalemia n Symptoms • • • Generalized fatigue Weakness Paresthesias Paralysis Palpitations Nonspecific！

Hyperkalemia n Symptoms • • • Generalized fatigue Weakness Paresthesias Paralysis Palpitations Nonspecific！

Hyperkalemia n Etiology 考題！ • Acute or chronic renal failure • Crush injuries (rhabdomyolysis),

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

Hyperkalemia n Mild: 5. 5 -6. 5 m. Eq/L • peaked T waves n

Hyperkalemia n Mild: 5. 5 -6. 5 m. Eq/L • peaked T waves n Moderate: 6. 5 -7. 5 m. Eq/L • • prolonged PR interval decreased P wave ST depression or elevation slight widening of the QRS

Hyperkalemia (cont. ) n Severe: 7. 5 -8. 5 m. Eq/L • wide QRS

Hyperkalemia (cont. ) n Severe: 7. 5 -8. 5 m. Eq/L • wide QRS • flat and wide P waves • VPCs n Life-threatening: >8. 5 m. Eq/L • • loss of P AV blocks VT / VF sinusoid patern

Hyperkalemia n Specific management: "See BIG Potassium Drop" • • • Calcium Bicarbonate Insulin

Hyperkalemia n Specific management: "See BIG Potassium Drop" • • • Calcium Bicarbonate Insulin and Glucose Kayexalate Dialysis 考題！

Hyperkalemia n General management: • Continuous ECG monitoring • DC K-sparing drugs (ACEI, spirinolactone)

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

Calcium n n n Stabilize cell membrane Calcium gluconate 10%, 10 ml over 2

Calcium n n n Stabilize cell membrane Calcium gluconate 10%, 10 ml over 2 -5 min 2 nd 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 !

Bicarbonate Shift K+ to intracellular n 3 amp Jusomine IV over 5 min n

Bicarbonate Shift K+ to intracellular n 3 amp Jusomine IV over 5 min n May repeat q 10 -15 min n Onset in 30 min; duration: 1 -2 hours n Avoid bicarbonate if: n • Hypocalcemia • Severe lung edema

Glucose and Insulin Redistribution n RI 10 U + D 50 GW 50 cc

Glucose and Insulin Redistribution n RI 10 U + D 50 GW 50 cc over 5 min n Consider Albuterol Neb as adjunct n Onset 50 -60 min; duration: several hours n Follow F/S n

Potassium Removal n Cation-Exchange resin (Kayexalate) • 15 -30 gm PO q 3 -4

Potassium Removal n Cation-Exchange resin (Kayexalate) • 15 -30 gm PO q 3 -4 hrs or 50 gm in 200 ml retention enema for 30 -60 min q 4 hr n Dialysis: May experience significant hyperkalemia on rebound

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

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