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Revision as of 14:49, 26 July 2013

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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.

Common Causes

Management

Shown below is an algorithm summarizing the approach to hyperkalemia.

 
 
 
 
 
 
 
 
High potassium level
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
R/O Pseudohyperkalemia
Repeat potassium level
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check vital signs
Stabilize the patient
Order an EKG
Concise history and physical exam
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess EKG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EKG changes, e.g. loss of P waves, hyperacute T waves and widened QRS
 
 
 
 
 
 
 
 
 
 
No changes in EKG, stable patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Use rapidly acting transient agents, e.g Insulin, Dextrose, IV Calcium; with Ca gluconate generally preferred over Ca chloride, inhaled Beta2 agonists
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Kayexalate, orally, and also can be given rectally in unconscious patients to avoid risks of aspiration
 
 
 
IV hydration
 
 
 
Stop potential causative medications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Use carefully in potential heart failure patients,
consider diuresis when clinically appropriate
 
 
 
Consult with nephrology for resistant and severe cases of hyperkalemia
may require urgent dialysis, yet rare
 

Do's

  • Place the patient on a closely monitored bed for potential fatal arrhythmias, esp. with levels higher than 6.5.
  • Repeat basic metabolic panels frequently.
  • Stop the offending medications that are associated with hyperkalemia.
  • Keep the patient well hydrated.
  • Check levels of other electrolytes such as Magnesium and phosphorus as it may be abnormal as well.
  • Consider consultation with nephrology.


Dont's

  • Don't over use kayexalate, as it has been reported to cause colonic transmural necrosis.[1]
  • Don't over treat with IV bicarbonate as it can lead to rebound metabolic alkalosis.

References

  1. Lillemoe KD, Romolo JL, Hamilton SR, Pennington LR, Burdick JF, Williams GM (1987). "Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis". Surgery. 101 (3): 267–72. PMID 3824154.


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