Hyperkalemia

Question 1

What is hyperkalemia?

Answer 1

Potassium level that exceeds 5.0 mEq/L

Question 2

What is pseudohyperkalemia?

Answer 2

A condition that can occur due to methods of blood specimen collection and cell lysis; if an increased serum value is obtained in the absence of clinical symptoms, the specimen should be redrawn and evaluated.

Question 3

What are three basic causes of hyperkalemia?

Answer 3

Excessive potassium intake
Decreased potassium excretion
Movement of potassium from the intracellular fluid to the extracellular fluid.

Question 4

What causes excessive potassium intake? (2)

Answer 4

Overingestion of potassium-containing foods or medications, such as potassium chloride or salt substitutes.
Rapid infusion of potassium-containing IV solutions.

Question 5

What causes decreased potassium excretion? (3)

Answer 5

Potassium-retaining diuretics
Kidney disease
Adrenal insufficiency, such as in Addison’s disease

Question 6

What causes movement of potassium from the intracellular fluid to the extracellular fluid? (4)

Answer 6

Tissue damage
Acidosis
Hyperuricemia
Hypercatabolism

Question 7

What are the cardiovascular signs and symptoms of hyperkalemia? (2)

Answer 7

Slow, weak, irregular heart rate

Decreased blood pressure

Question 8

What are the respiratory signs and symptoms of hyperkalemia?

Answer 8

Profound weakness of the skeletal muscles leading to respiratory failure.

Question 9

What are the early neuromuscular signs and symptoms of hyperkalemia? (3)

Answer 9

Muscle twitches
Cramps
Paresthesias (tingling and burning followed by numbness in the hands and feet and around the mouth)

Question 10

What are the late neuromuscular signs and symptoms of hyperkalemia? (2)

Answer 10

Profound weakness
Ascending flaccid paralysis in the arms and legs (trunk, head, and respiratory muscles become affected when the serum potassium level reaches a lethal level)

Question 11

What are the gastrointestinal signs and symptoms of hyperkalemia? (2)

Answer 11

Increased motility, hyperactive bowel sounds

Diarrhea

Question 12

What are the laboratory findings that indicate hyperkalemia?

Answer 12

Serum potassium level that exceeds 5.0 mEq/L

ECG changes

Question 13

What are the ECG changes that indicate hyperkalemia?

Answer 13

Tall peaked T waves, flat P waves, widened QRS complexes, and prolonged PR intervals

Question 14

What systems should the nurse monitor in a patient with hyperkalemia?

Answer 14

Cardio, resp, neuromuscular, renal, and gastro

Question 15

What medications may be administered to the patient with hyperkalemia if renal function is not impaired?

Answer 15

Potassium excreting diuretics

Question 16

What medication may be administered to the patient with hyperkalemia if renal function is impaired? How does this medication work?

Answer 16

Sodium polysystrene sulfonate (Kayexalate) - a cation-exchange resin that promotes gastrointestinal sodium absorption and potassium excretion

Question 17

What treatment might the patient need if potassium levels are extremely high?

Answer 17

Dialysis

Question 18

What might be given intravenously if hyperkalemia is severe to avert myocardial excitability?

Answer 18

IV calcium

Question 19

What is used to move excess potassium into the cells?

Answer 19

IV administration of hypertonic glucose with regular insulin