Hyperkalemia resident survival guide: Difference between revisions

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{{familytree | | | |:| | | | E01 | | | | | | | | | | | E02 |E01=Potassium > 6 mEq/L|E02= 5.5mEq/L<Potassium<6mEq/L}}
{{familytree | | | |:| | | | E01 | | | | | | | | | | | E02 |E01=Potassium > 6 mEq/L|E02= 5.5mEq/L<Potassium<6mEq/L}}
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{{familytree | | | |:| | | | F01 | | | | | | | | | | | F02 | |F01='''1. Monitor for cardiac arrhythmia'''<br>Place the patient on a closely monitored bed for potential arrhythmias<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>Loop diuretics (furosemide)<Hemodialysis if refractory|F02='''Lower total body potassium'''<br>Kayexalate<br>Loop diuretics (furosemide)}}
{{familytree | | | |:| | | | F01 | | | | | | | | | | | F02 | |F01='''1. Monitor for cardiac arrhythmia'''<br>Place the patient on a closely monitored bed for potential arrhythmias<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>Loop diuretics (furosemide)<br>Hemodialysis if refractory|F02='''Lower total body potassium'''<br>Kayexalate<br>Loop diuretics (furosemide)}}
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Revision as of 18:54, 27 July 2013

Hyperkalemia Microchapters

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Differentiating Hyperkalemia from other Diseases

Epidemiology and Demographics

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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.

{{familytree | | | D01 | | | | | | | | | | |!|D01= 1. Myocardial stabilization
IV Ca gluconate 10% (contraindicated in digoxin toxicity and hypercalcemia)

2. Shift potassium from blood into cells
Insulin and dextrose (glucose level monitoring is needed)
Beta2 agonists by nebulizer (can cause tachycardia)

3. Lower total body potassium
Kayexalate
Loop diuretics (furosemide)
Hemodialysis if refractory}

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

Repeat potassium level
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check vital signs
ABC's
Order an EKG
Obtain a concise history and physical exam
Order BUN, creatinine, glucose, ABG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess EKG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EKG changes, e.g. loss of P waves, hyperacute T waves and widened QRS
 
 
 
 
 
 
 
 
 
No changes in EKG

and

Stable patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Potassium > 6 mEq/L
 
 
 
 
 
 
 
 
 
 
5.5mEq/L<Potassium<6mEq/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1. Monitor for cardiac arrhythmia
Place the patient on a closely monitored bed for potential arrhythmias

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

3. Lower total body potassium
Kayexalate
Loop diuretics (furosemide)
Hemodialysis if refractory
 
 
 
 
 
 
 
 
 
 
Lower total body potassium
Kayexalate
Loop diuretics (furosemide)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stop any offending medications that are associated with hyperkalemia

Stop oral or parenteral potassium

Review potassium levels every 2-4 hours until stabilized

Check levels of other electrolytes such as magnesium and phosphorus
 
 
 
 
 
 
 
 
 
 
 
 
 

References


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