Hyperkalemia

Question 1

What is the definition of hyperkalemia?

Answer 1

K >5

Question 2

First step in workup of hyperkalemia?

Answer 2

Recheck.

Question 3

Most common cause of hyperkalemia?

Answer 3

Spurious. Hemolysis of blood samples (fist clenching), extreme WBCs/thrombocytosis, rhabdo.

Question 4

What causes decreased excretion of potassium?

Answer 4

Renal insufficiency. Drugs (low aldo state- spironolactone, ACEIs, NSAIDs, triamterene (thiazide diuretic).

Question 5

What causes outward cellular shift of potassium?

Answer 5

Tissue injury, insulin deficiency, acidosis, drugs (succhylcholine, digitalis, arginine, beta blockers).

Question 6

If hyperkalemia is confirmed, what’s the first thing you check?

Answer 6

EKG!!

Question 7

What changes are you looking for on EKG for hyperkalemia?

Answer 7

Peaked t waves, widened QRS, loss of p waves, PR prolongation. Can progress to sine waves - v-fib, cardiac arrest.

Question 8

What is the “alarm” value of hyperkalemia requiring emergent treatment?

Answer 8

> 6.5 or EKG changes.

Question 9

What is the treatment of hyperkalemia?

Answer 9

1. Calcium gluconate for cardiac cell membrane stabilization.
2. Give B-agonists OR bicarb OR insulin + D5 to shift K+ into cells.
3. Give loop diuretics or kayexalate to remove K+ from the body. Dialysis if renal failure or very severe.