Hyperkalemia

Question 1

What is the definition of hyperkalemia?

Answer 1

potassium level >5.5

Question 2

Clinical sxs of hyperkalemia:

Answer 2

fatigue, weakness, palpitations, paresthesias

Question 3

EKG changes of hyperkalemia:

what does it do to the PR interval? QT interval?

Answer 3

peaked T waves 
Increased PR interval
widened QRS 
Decreased QT interval
decreased P wave amplitude

Question 4

How do the adrenal glands contribute to hyperkalemia?

Answer 4

adrenal insufficiency can cause hyperkalemia

Deficiency of aldosterone= More K

Question 5

How to manage hyperkalemia:

First steps, then what?

Answer 5

If there are no EKG signs, send STAT VBG or ABG to confirm before instituting tx
If real and K is greater than 6.0, or if EKG changes are present:
-calcium gluconate 10% 10 mL IV over 2-3 min -raises threshold potential
-Insulin 10 units IV with 50 mL of 50% dextrose (shifts K+ into cells) No effect on total body K+
-Albuterol 10-20 mg via neb over 10 minutes-shifts K+ into cells

periodically check ABG
NAHCO3 50-150
treat metabolic acidosis
mild hyperventilation

Force diuresis: furosemide 10 mg IV -consider HD if life threatening or accompanied by volume overload.

Question 6

If hyperkalemia is mild, what can you give?

Answer 6

cation exchange resins (Kayexalate) can be used to exchange K+ for Na+ in the gut