Hyperkalemia resident survival guide: Difference between revisions

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{{familytree | | | | A01 |~|~| A02 | | | | | |A01= If repeated potassium level is normal, check potassium level in 24 hours|A02='''R/O Pseudohyperkalemia'''<br>(Artifact, hemolysis, elevated WBC, elevated RBC, elevated platelets)<br><br>Repeat potassium level}}
{{familytree | | | | A01 |~|~| A02 | | | | | |A01= If repeated potassium level is normal, check potassium level in 24 hours|A02='''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>ABC's<br>Order an [[EKG]]<br>Obtain a concise history and physical exam<br>Order BUN, creatinine, glucose, ABG}}
{{familytree | | | | | | | | | A02 | | | | | |A02=Check [[vital signs]]<br>ABC's<br>Order an [[EKG]]<br>Obtain a concise history and physical exam<br>Order [[BUN]], [[creatinine]], [[glucose]], [[ABG]]}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | B01 | | | | | |B01='''Assess [[EKG]]'''}}
{{familytree | | | | | | | | | B01 | | | | | |B01='''Assess [[EKG]]'''}}
{{familytree | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| }}
{{familytree | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| }}
{{familytree | | | C01 | | | | | | | | | | C02 | |C01='''Presence of [[EKG]] changes'''<br>(Loss of P waves, hyperacute T waves and widened QRS)<br>[[Image:EKG_hyperkalemia.gif|center|250px]]|C02='''Absence of [[EKG]] changes'''<br><br> '''and''' <br><br>'''Stable patient'''}}
{{familytree | | | C01 | | | | | | | | | | C02 | |C01='''Presence of [[EKG]] changes'''<br>(Loss of [[P wave]]s, hyperacute [[T wave]]s and widened [[QRS]])<br>[[Image:EKG_hyperkalemia.gif|center|250px]]|C02='''Absence of [[EKG]] changes'''<br><br> '''and''' <br><br>'''Stable patient'''}}
{{familytree | | | |!| | | | | | | | | | | |!| |}}
{{familytree | | | |!| | | | | | | | | | | |!| |}}
{{familytree | | | D01 | | | | | | | | | | |!|D01= '''1. Myocardial stabilization'''<br>IV [[calcium lactate gluconate|Ca gluconate]] (1-2 amps)<br>Contraindicated in digoxin toxicity and hypercalcemia<br><br>'''2. Shift potassium from blood into cells'''<br>[[Insulin]] (0.2 units for every gram of glucose administered) and 20%[[dextrose]] ( 2.5-5 ml/kg/h)<br>Glucose level monitoring is needed<br><br>[[Beta2-adrenergic receptor agonist|Beta2 agonists]] (albuterol is given 10-20mg via nebulizer or 0.5 mg IV)<br><br>'''3. Lower total body potassium'''<br>Cation exchange resin (kayexalate 30-90g given P.O. or P.R.)<br><br>Loop diuretics (furosemide 1-2 mg/kg)<br><br>Hemodialysis if refractory}}
{{familytree | | | D01 | | | | | | | | | | |!|D01= '''1. Myocardial stabilization'''<br>IV [[calcium lactate gluconate|Ca gluconate]] (1-2 amps)<br>Contraindicated in [[digoxin]] toxicity and hypercalcemia<br><br>'''2. Shift potassium from blood into cells'''<br>[[Insulin]] (0.2 units for every gram of glucose administered) and 20% [[dextrose]] ( 2.5-5 ml/kg/h)<br>Glucose level monitoring is needed<br><br>[[Beta2-adrenergic receptor agonist|Beta2 agonists]] ([[albuterol]] is given 10-20mg via nebulizer or 0.5 mg IV)<br><br>'''3. Lower total body potassium'''<br>[[Cation exchange resin]] ([[kayexalate]] 30-90g given P.O. or P.R.)<br><br>[[Loop diuretics]] ([[furosemide]] 1-2 mg/kg)<br><br>[[Hemodialysis]] if refractory}}
{{familytree | | | |:| | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.|}}
{{familytree | | | |:| | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.|}}
{{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'''}}
{{familytree | | | |:| | | | |!| | | | | | | | | | | | |!| | | | }}
{{familytree | | | |:| | | | |!| | | | | | | | | | | | |!| | | | }}
{{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]] (0.2 units for every gram of glucose administered) and 20%[[dextrose]] ( 2.5-5 ml/kg/h)<br>Glucose level monitoring is needed<br><br>[[Beta2-adrenergic receptor agonist|Beta2 agonists]] (albuterol is given 10-20mg via nebulizer or 0.5 mg IV)<br><br>'''3. Lower total body potassium'''<br>Cation exchange resin (kayexalate 30-90g given P.O. or P.R.<br>Loop diuretics (furosemide 1-2 mg/kg)<br><br>Hemodialysis if refractory|F02='''Lower total body potassium'''<br>Cation exchange resin (kayexalate 30-90g given P.O. or P.R.)<br><br>Loop diuretics (furosemide 1-2 mg/kg)}}
{{familytree | | | |:| | | | F01 | | | | | | | | | | | F02 | |F01='''1. Monitor for cardiac arrhythmia'''<br>Place the patient on a closely monitored bed for potential [[arrhythmia]]s<br><br>'''2. Shift potassium from blood into cells'''<br>[[Insulin]] (0.2 units for every gram of [[glucose]] administered) and 20%[[dextrose]] ( 2.5-5 ml/kg/h)<br>Glucose level monitoring is needed<br><br>[[Beta2-adrenergic receptor agonist|Beta2 agonists]] ([[albuterol]] is given 10-20mg via nebulizer or 0.5 mg IV)<br><br>'''3. Lower total body potassium'''<br>[[Cation exchange resin]] ([[kayexalate]] 30-90g given P.O. or P.R.<br>[[Loop diuretics]] ([[furosemide]] 1-2 mg/kg)<br><br>[[Hemodialysis]] if refractory|F02='''Lower total body potassium'''<br>[[Cation exchange resin]] ([[kayexalate]] 30-90g given P.O. or P.R.)<br><br>Loop diuretics (furosemide 1-2 mg/kg)}}
{{familytree | | | |:| | | | |:| | | | | | | | | | | | |:| | | | }}
{{familytree | | | |:| | | | |:| | | | | | | | | | | | |:| | | | }}
{{familytree | | | |L|~|~|~|~|%|~|~|~|~|~|~|~|~|~|~|~|~|J| | | }}
{{familytree | | | |L|~|~|~|~|%|~|~|~|~|~|~|~|~|~|~|~|~|J| | | }}
{{familytree | | | | | | | | G01  | | | | | | | | | | | | | |G01=Stop any offending medications that is associated with [[hyperkalemia]]<br><br>Stop oral or parenteral potassium<br><br>Review potassium levels every 2-4 hours until stabilized<br><br>Check levels of other [[electrolyte|electrolytes]] such as [[magnesium]] and [[phosphorus]]}}
{{familytree | | | | | | | | G01  | | | | | | | | | | | | | |G01=D/C any offending medications that is associated with [[hyperkalemia]]<br><br>D/C oral or parenteral potassium<br><br>Correct [[acidosis]] with bicarb if pH<7.2<br><br>Restrict dietary potassium intake<br><br>Review potassium levels every 2-4 hours until stabilized<br><br>Check levels of other [[electrolyte|electrolytes]] such as [[magnesium]] and [[phosphorus]]}}
{{familytree/end}}
{{familytree/end}}



Revision as of 19:33, 27 July 2013

Hyperkalemia Microchapters

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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.

 
 
 
 
 
 
 
 
Potassium > 5.5 mEq/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If repeated potassium level is normal, check potassium level in 24 hours
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of EKG changes
(Loss of P waves, hyperacute T waves and widened QRS)
 
 
 
 
 
 
 
 
 
Absence of EKG changes

and

Stable patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
1. Myocardial stabilization
IV Ca gluconate (1-2 amps)
Contraindicated in digoxin toxicity and hypercalcemia

2. Shift potassium from blood into cells
Insulin (0.2 units for every gram of glucose administered) and 20% dextrose ( 2.5-5 ml/kg/h)
Glucose level monitoring is needed

Beta2 agonists (albuterol is given 10-20mg via nebulizer or 0.5 mg IV)

3. Lower total body potassium
Cation exchange resin (kayexalate 30-90g given P.O. or P.R.)

Loop diuretics (furosemide 1-2 mg/kg)

Hemodialysis if refractory
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 (0.2 units for every gram of glucose administered) and 20%dextrose ( 2.5-5 ml/kg/h)
Glucose level monitoring is needed

Beta2 agonists (albuterol is given 10-20mg via nebulizer or 0.5 mg IV)

3. Lower total body potassium
Cation exchange resin (kayexalate 30-90g given P.O. or P.R.
Loop diuretics (furosemide 1-2 mg/kg)

Hemodialysis if refractory
 
 
 
 
 
 
 
 
 
 
Lower total body potassium
Cation exchange resin (kayexalate 30-90g given P.O. or P.R.)

Loop diuretics (furosemide 1-2 mg/kg)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
D/C any offending medications that is associated with hyperkalemia

D/C oral or parenteral potassium

Correct acidosis with bicarb if pH<7.2

Restrict dietary potassium intake

Review potassium levels every 2-4 hours until stabilized

Check levels of other electrolytes such as magnesium and phosphorus
 
 
 
 
 
 
 
 
 
 
 
 
 

References


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