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Hyperkalemia Flashcards

1
Q

Define Hyperkalemia

A

Serum potassium>=5.5 mEq/l

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2
Q

What is considered mild, moderate and severe hyperkalemia

A

Mild: 55-5.9 mEq/L
Moderate: 6-6.4 mEq/L
Severe:>=6.5 mEq/l

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3
Q

Which body tissue has most potassium?

A

Skeletal muscles(75% of total body potassium)

Normal potassium range: 3.5-5.5 mEq/l(mmol/L)

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4
Q

What type of hyperkalemia occurs as a result of laboratory error?

A

Pseudohyperkalemia

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5
Q

List three common causes of pseudohyperkalemia.

A
  1. Hemolysis during blood drawing
  2. Hemolysis before lab analysis
  3. Hyperviscosity due to thrombocytosis, polycythemia Vera/leucocytosis
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6
Q

What are 4 common causes of hemolysis during blood drawing?

A
  1. Prolonged tourniquet on arm
  2. Small needles
  3. Excessive force to pull blood into the tube
  4. Excessive fist clenching
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7
Q

What are two common causes of hemolysis before lab analysis?

A
  1. Aggressive sample shaking
  2. Delay between blood drawing and analysis
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8
Q

What is the management of pseudohyperkalemia?

A

Retake the sample

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9
Q

What is the best initial test for hyperkalemia?

A

ECG-Shows hyperacute/peaked T waves with narrow bases in V2-4(earliest finding), broad QRS and prolonged PR interval

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10
Q

What is the earliest ECG finding of hyperkalemia?

A

Tall peaked T waves in V2-4 especially when they are taller than R waves(very sensitive sign)

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11
Q

What is the most dangerous EKG finding of Hyperkalemia?

A

Widening QRS complexes: It can merge with abnormal T waves forming sine wave appearing ventricular Tachycardia

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12
Q

List 4 EKG findings of hyperkalemia in ascending order.

A
  1. Tall peaked T waves
  2. PR prolongation
  3. QRS widens: Form sine wave V Tachycardia when they marge with abnormal T waves
  4. Decrease in P wave amplitude=>Nodal rhythm with absent p.waves
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13
Q

Which EKG findings is associated with potassium level of 8 mEq/L.and the complication of such level?

A

Sine wave pattern: merging of S waves with T waves

Become Ventricular fibrillation and cardiac arrest shortly afterwards

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14
Q

Which EKG finding is associated with potassium levels of 6.5-7.5 mEq/L?

A

Nodal rhythm with absent p waves

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15
Q

Tall peaked T waves on ECG are associated with what serum potassium levels?

A

5.5-6.5

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16
Q

List 4 ECG features of Hyperkalemia(K>=9).

A
  1. Asystole
  2. Ventricular fibrillation
  3. Pulse less electrical activity bizarre wide complexes
  4. Sine wave pattern(S and T waves join)
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17
Q

List three EKG findings of Hyperkalemia( K:7-8.9)

A
  1. Bradyarrhythmia
  2. Conduction blocks(BBB/fascicular blocks)
  3. Prolonged QRS interval with bizarre QRS morphology
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18
Q

What is the discharge criteria for hyperkalemia?

A

Normal serum potassium levels

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19
Q

Who to admit to the ICU with hyperkalemia?

A
  1. Persistent Hyperkalemia even after treatment
  2. Underlying condition mandate admission(severe renal failure)
  3. Cardiac toxicity occured
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20
Q

What guides the treatment of hyperkalemia?

A
  1. Serum potassium levels
  2. Renal function
  3. Presence/absence of ECG changes
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21
Q

What is the initial treatment for hyperkalemia?

A

10% Calcium carbonate/calcium chloride in 10 ml IV slowly over 10 minutes

NOTE: DO NOT LOWER TOTAL BODY POTASSIUM

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22
Q
A
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23
Q

What should be added to calcium carbonate/calcium chloride in the management of hyperkalemia first?

A

Dextrose 50% 100ml IV with insulin 10 units over 15-30 minutes

Followed by salbutamol 5 mg nebulized(Dilute in 4ml of NaCl 0.9%)

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24
Q

What is the adverse effect of insulin?

A

Hypoglycemia (look out for it)

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25
Q

When is bicarbonate 50-100 ml of 8.4% added in the management of Hyperkalemia?

A

Only add if metabolic acidosis is present/occurs

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26
Q

Should bicarbonate be given in the same site as calcium carbonate?

A

Nope, they will precipitate

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27
Q

What are the commonest adverse effects of Salbutamol?

A
  1. Tachyarrhythmias(Deadly)
  2. Tremors
  3. Flushing
  4. Anxiety
28
Q

What are the 3.commonest adverse effects of calcium carbonate?

A

1.Arrhythmias
2. Tissues necrosis if extravasated
3. Bradycardia

NOTE: It does not lower potassium levels

29
Q

What is the rate of potassium reduction by insulin+dextrose?

A

0.6-1 mmol/L/hour

30
Q

Which one between calcium chloride and calcium carbonate have more Calcium ions?

A

calcium gluconate = 2.2mmol of Ca2+ in 10mL
calcium chloride = 6.8mmol of Ca2+ in 10mL

31
Q

Which one between calcium chloride and calcium carbonate is more likely to lead to tissue necrosis?

A

Calcium chloride: It has more calcium ions

calcium gluconate = 2.2mmol of Ca2+ in 10mL
calcium chloride = 6.8mmol of Ca2+ in 10mL

32
Q

List three exogenous sources of potassium that commonly lead to Hyperkalemia

A
  1. Massive blood transfusion
  2. High dose potassium penicillin
  3. Poisoning/ingestion
33
Q

List 6 causes of hyperkalemia due to reduction in excretion.

A
  1. Decreased glomerular filtration rate(Renal Injury)
  2. Heart failure
  3. Obstructive uropathy
  4. Low aldosterone level due to drenal insufficiency (Addison disease)and Low renin level
  5. Type 4 renal tubular acidosis
  6. edications that inhibit Na-K ATPase in the distal nephron
34
Q

What is the most common cause of Hyperkalemia?

A

Spurious elevation

37
Q

What is most.common cause of true hyperkalemia?

A

Chronic Kidney failure

38
Q

List 5 common drugs that cause hyperkalemia

A
  1. Nonsteroidal anti-inflammatory drugs,
  2. Potassium-sparing diuretics,
  3. digoxin,
  4. angiotensin-converting enzyme inhibitors
  5. administration of intravenous potassium chloride
39
Q

List 5 common causes of hyperkalemia through cell death.

A
  1. Rhabdomyolysis
  2. Hemolysis(Intravascular)
  3. Tumour lysis syndrome
  4. Crush injuries
  5. Burns
40
Q

Much less common causes of hyperkalaemia include adrenal insufficiency, hyperkalaemic periodic paralysis, and hematologic malignancies.

A

JUST MEMORIZE

41
Q

Most patients with hyperkalemia are symptomatic.

A

False. Only symptomatic when it is severe

42
Q

State three neurological exam findings for hyperkalemia

A
  1. Decreased deep tendon reflexes
  2. Decreased power
  3. Intact sensation
43
Q

What Physical exam findings are typical for hyperkalemia?

A

Bradycardia or irregular rhythm with premature contractions

44
Q

State the typical presentation of hyperkalemia.

A

Muscle cramps, paresthesias, and weakness that can progress to a flaccid paralysis

Patients may experience palpitations or generalized fatigue and malaise.

46
Q

Name 4 drugs that lead to reduction in aldosterone release/activity that leads to Hyperkalemia

A
  1. ACE inhibitors
  2. Angiotensin receptor blockers
  3. Aldosterone inhibitors: Spironolactone and eplerenone
  4. Potassium-sparing diuretics:Triamtene and Amilorode
47
Q

Which cause of metabolic acidosis is associated with hyperkalemia and hyporenin hypoaldosteroiism

A

Renal tubular acidosis type 4

48
Q

Give the names of three drugs that lead to Hyperkalemia through increased release of K.

A
  1. Beta blockers
  2. Digoxin
  3. Heparin
49
Q

Four.coon clinical features of Hyperkalemia

A
  1. Muscle weakness
  2. Cardiac rhythm disorder
  3. Flaccid paralysis
  4. Paralytic ileus
50
Q

Is hyperkalemia associated with seizures

51
Q

List EKG findings of severe Hyperkalemia.

A
  1. Tall peaked T waves
  2. PR prolongation
  3. Wide QRS
52
Q

Can you give calcium carbonate if the EVG is normal?

53
Q

In addition to the initial management of lowering potassium what other options are available?

A
  1. Kayoxelate
  2. Dialysis
  3. Loop diuretic furosemide 1-2 mg
  4. Oral potassium binders(parieomer or zirconium) for long term therapy
54
Q

If there are no EVG changes, state how you would treat hyperkalemia?

A

Insulin and dextrose 50% in 100 ml

You can add furosemide and Kayexalate

56
Q

List causes of hyperkalemia due to shift of potassium out of the cell.

A
  1. Haemolysis (Rhabdomyolysis; Tumour lysis syndrome and Haematoma reabsorption)
  2. Medications that inhibit Na-K ATPase pump
  3. Insulin deficiency including Diabetes mellitus and Prolonged fasting
  4. Hypertonicity including Hyperglycaemia and hypernatremia
  5. Acidosis
  6. Hyperkalemia periodic paralysis (mutation of skeletal muscle Na-K pump)
57
Q

Why is hemodialysis the best for hyperkalemia

A
  1. Can remove 25-40mmol/hr -> 1mmol/L/hr
  2. Faster if increase blood flow rate, dialysis flow rate, low K+ concentration in dialysate, high bicarbonate concentration
58
Q

Can prolonged immobility and/or seizures cause Hyperkalemia

59
Q

When can someone get Hyperkalemia as a result of increased dietary intake?

A

In the presence of renal failure/dysfunction

Note: If kidney function is normal, it is almost impossible to ingest potassium faster than the kidney can excrete it

60
Q

Is the rate of potassium excretion higher than the rate of potassium absorption by the gut?

61
Q

Outline how beta blockers lead to Hyperkalemia.

A

Normal Na/K ATPase activity lowers blood potassium. Beta-blockers decrease the activity of the sodium/potassium ATPase. When you inhibit Na/K ATPase with a beta-blocker,
potassium levels can go up

62
Q

How does heparin cause Hyperkalemia?

A

By inhibiting aldosterone.

63
Q

What is the first line treatment of Hyperkalemia without.EKG changes?

A

IV insulin and dextrose

64
Q

What are the indications for bicarbonate in management of Hyperkalemia?

A
  1. Acidosis
  2. Rhabdomyolysis
  3. Hemolysis
  4. Anything that alkalanize the urine

Acute Care (15 decks)

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