Hyperkalemia resident survival guide: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 37: Line 37:
{{familytree | | | | | | | | | A00 | | | | | |A00=Potassium > 5.5 mEq/L}}
{{familytree | | | | | | | | | A00 | | | | | |A00=Potassium > 5.5 mEq/L}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | A01 | | | | | |A01=R/O Pseudohyperkalemia<br>Repeat potassium level}}
{{familytree | | | | | | | | | A01 | | | | | |A01=R/O Pseudohyperkalemia<br>(Artifact, hemolysis, elevated WBC, elevated RBC, elevated platelets)<br><br>Repeat potassium level}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | A02 | | | | | |A02=Check [[vital signs]]<br>Stabilize the patient<br>Order an [[EKG]]<br>Obtain a concise history and physical exam}}
{{familytree | | | | | | | | | A02 | | | | | |A02=Check [[vital signs]]<br>Stabilize the patient<br>Order an [[EKG]]<br>Obtain a concise history and physical exam}}
Line 45: Line 45:
{{familytree | | | C01 | | | | | | | | | | | |!| |C01=[[EKG]] changes, e.g. loss of P waves, hyperacute T waves and widened QRS<br>[[Image:EKG_hyperkalemia.gif|center|350px]]}}
{{familytree | | | C01 | | | | | | | | | | | |!| |C01=[[EKG]] changes, e.g. loss of P waves, hyperacute T waves and widened QRS<br>[[Image:EKG_hyperkalemia.gif|center|350px]]}}
{{familytree | | | |!| | | | | | | | | | | | |!| |}}
{{familytree | | | |!| | | | | | | | | | | | |!| |}}
{{familytree | | | D01 | | | | | | | | | | | D02 |D01= IV [[calcium lactate gluconate|Ca gluconate]]<br>Rapidly acting transient agents: [[Insulin]] and [[glucose]]<br>[[Beta2-adrenergic receptor agonist|Beta2 agonists]] by nebulizer|D02=No changes in [[EKG]]<br><br> And <br><br>Stable patient}}
{{familytree | | | D01 | | | | | | | | | | | D02 |D01= '''1. Myocardial stabilization'''<br>IV [[calcium lactate gluconate|Ca gluconate]]<br><br>'''2. Shift potassium from blood into cells'''<br>[[Insulin]] and [[dextrose]]<br>[[Beta2-adrenergic receptor agonist|Beta2 agonists]] by nebulizer<br><br>'''3. Lower total body potassium'''<br>Kayexalate<br>Furosemide<Hemodialysis if refractory|D02=No changes in [[EKG]]<br><br> And <br><br>Stable patient}}
{{familytree | | | |:| | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.|}}
{{familytree | | | |:| | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.|}}
{{familytree | | | |:| | | | | | E01 | | | | | | | | | E02 |E01=Potassium > 6|E02= 5.5mEq/L < Potassium < 6 mEq/L}}
{{familytree | | | |:| | | | | | E01 | | | | | | | | | E02 |E01=Potassium > 6|E02= 5.5mEq/L < Potassium < 6 mEq/L}}

Revision as of 18:29, 27 July 2013

Hyperkalemia Microchapters

Home

Patient information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hyperkalemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural history, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hyperkalemia resident survival guide On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hyperkalemia resident survival guide

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hyperkalemia resident survival guide

CDC on Hyperkalemia resident survival guide

Hyperkalemia resident survival guide in the news

Blogs on Hyperkalemia resident survival guide

Directions to Hospitals Treating Hyperkalemia

Risk calculators and risk factors for Hyperkalemia resident survival guide

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.

 
 
 
 
 
 
 
 
Potassium > 5.5 mEq/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
R/O Pseudohyperkalemia
(Artifact, hemolysis, elevated WBC, elevated RBC, elevated platelets)

Repeat potassium level
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check vital signs
Stabilize the patient
Order an EKG
Obtain a concise history and physical exam
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess EKG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EKG changes, e.g. loss of P waves, hyperacute T waves and widened QRS
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1. Myocardial stabilization
IV Ca gluconate

2. Shift potassium from blood into cells
Insulin and dextrose
Beta2 agonists by nebulizer

3. Lower total body potassium
Kayexalate
Furosemide<Hemodialysis if refractory
 
 
 
 
 
 
 
 
 
 
No changes in EKG

And

Stable patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Potassium > 6
 
 
 
 
 
 
 
 
5.5mEq/L < Potassium < 6 mEq/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rapidly acting transient agents: Insulin and glucose
Beta2 agonists by nebulizer

Place the patient on a closely monitored bed for potential arrhythmias
 
 
 
 
 
 
 
 
Kaexalate (orally, and also can be given rectally in unconscious patients to avoid risks of aspiration)
Furosamide
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stop the offending medications that are associated with hyperkalemia

Order spot urine potassium, osmolality, creatinine

Check levels of other electrolytes such as magnesium and phosphorus as it may be abnormal as well
 
 
 
 
 
 
 
 
 
 
 
 
 

References


Template:WikiDoc Sources