#20 Press - Hyperkalemia Flashcards
Your patient just had an EKG done and you see a “tent on the desert”, prolonged QT interval. What do you realize has happened to the potassium level?
Hyperkalemia
Hypocalcemia
Your patient just had an EKG done and you see an “Eiffel tower” , tall peaked T wave. What do you realize has happened to the potassium level?
Hyperkalemia
Your patient just got diagnosed with hyperaldosterone. The blood work came back and the blood serum levels are hypokalemic. Where is the potassium going?
Urine - potassium excretion is stimulated by high plasma aldosterone concentration
Aldosterone stimulates sodium reabsorption by increasing number of sodium channels
In what circumstance would increasing potassium intake cause hyperkalemia?
CKD; impaired excretion
SHGR is a type II diabetic and is usually hyperglycemic. What is the likely potassium level in her serum?
Hyperkalemia
Treat the insulin deficiency and reduce K+
AC has metabolic acidosis. Why is she also hyperkalemic?
Buffering of excess hydrogen ions in the cells can lead to potassium movement into the extracellular fluid.
Your patient has reduced GFR and just got diagnosed with hypoaldosterone. The blood work came back and you suspect the blood serum levels for potassium may be ______?
hyperkalemic
reduced urinary potassium excretion
What could cause a pseudohyperkalemia on a blood draw?
Repeated fist clinching
Exercise can also induce a degree of elevation.
A patient comes in complaining of muscle weakness and sometimes paralysis in the lower extremities. What is one thing you will check for on labs?
Hyperkalemia
-ease of generating an action potential is related to the magnitude of the resting potential
A patient has reduced urinary potassium excretion. What ddx might you think of?
Hypoaldosteronism
Renal failure
Hyperkalemic type 1 renal tubular acidosis (defect in sodium reabsorption)
Impaired potassium secretion (acute transplant rejection, lupus nephritis, cyclosporin treated patient)
Ureterojejunostomy
You are on rotations and Dr. Press asks you when you would begin treatment for someone who is hyperkalemic? What treatment would you give?
- a potassium greater than or equal to 7 meq/l
- EKG changes
- Neuromuscular abnormalities
Ca2+ gluconate
Your patient has a systemic pH of 7.2 and a HCO3 level of 20 mmHg. How could adding bicarbonate help your hyperkalemic acidotic patient?
Raising pH will result in movement of H+ out of the cell and K+ into the cell to maintain electroneutrality.
Why would you not use albuterol to lower hyperkalemia in a CAD patient?
Tachycardia which may exacerbate ischemia in CAD patients.
To definitively remove potassium from the body, what treatments might you use?
Diuretics
Cation exchange resin
Dialysis
Sodium Polystyrene Sulfonate is a cation exchange resin which can be used to to eliminate potassium via the gut. When could you use Kayexalate?
Removing potassium overnight when waiting for dialysis the next day.
