Hyperkalemia/Hypokalemia Flashcards

1
Q

How much of dietary K is excreted?

A

90-95

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2
Q

Where is the potassium excreted from the kidneys?

A

Principle cell

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3
Q

What controls K excretion?

A

Na delivery to distal tubule

  • Metabolic alkalosis
  • Aldosterone
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4
Q

How does increased distal Na?

A

Increased K excretion + increased H excretion

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5
Q

What push K into the cells?

A

Insulin +

Catecholamines

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6
Q

How does insulin push K into cells?

A

Activates Na/K pump

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7
Q

How do catecholamines (B2) work to put K into cell?

A

Activates Na/K pump

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8
Q

What does acidosis do to K in the body?

A

Shift of H+ into cells while K+ out of cell

- Hyperkalemia

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9
Q

How does hyperglycemia do hyperkalemia?

A

Solvent drag (water out) + water pulls K+ too

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10
Q

How does Cell lysis cause hyperkalemia?

A

Rhabdomyolysis, tumor lysis

- Also get Hyperphosphatermia + high serum uric acid

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11
Q

How does cell proliferation cause hypo kalemia?

A

Rapidly proliferating cells need more K+

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12
Q

What other labs should you check during hypokalemia?

A

Mag,
Urine Chloride
Ux (24h)
TTKG

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13
Q

What does magnesium show in K disorders?

A

Order for hypokalemia
Mech: Mag blocks K excretion
- Hypomag = increased K excretion

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14
Q

How does Urine Chloride lab show?

A

Hypokalemia, Metabolic alkalosis

- Saline Responsive: Urine Cl 20 (hyperaldosteronism)

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15
Q

What is the breakdown of Hyperkalemia?

A

Problem of either external balance or internal balance

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16
Q

What is the defect of internal balance of hyperkalemia?

A
Insulin def.
Cell lysis
Hypertonicity
B2 adrenergic blockade
Acidemia
DKA
Rhabdo, hemolysis, tumor lysis, burns, crush injury
Hyperglycemia,
B-Blockers, Metabolic acidosis, Resp acidosis
17
Q

What is a defect external balance of hyperkalemia?

A

Decreased renal K excretion

  • Acute + Chronic kidney disease
  • Decreased distal sodium delivery
  • Decreased distal tubular function
  • Aldosterone deficiency
  • Volume depletion, decreased EABV (CHF, cirrhosis)
  • Interstitial nephritis
  • ACEI/ARB, K-sparing (spironolactone, triamterene), Addision, RTA IV
18
Q

What is pseudohyperkalemia?

A

Causes:

  • severe leukocytosis/thrombocytosis/erythrocytosis
  • Hemolysis during draw
  • Processing delay
  • Potassium leak from increased blood cells present
  • Platelets release potassium during clotting process
19
Q

What are the clinical manifestations of Hyperkalemia?

A

Cardiac toxicity (EKG, Arrythmias, conduction defects)

  • Mild: Peaked T waves
  • Moderate: Wide QRS complex, prolonged PR interval, shortened QT interval
  • Severe: Widening of QRS complex (sine waves), absent P-wave
20
Q

When to treat hyperkalemia?

A

Urgent K>6

21
Q

How to treat high K?

A

C BIG KD2

  • Ca gluconate
  • Bicarb
  • Insulin/Glucose
  • Kayexalte
  • Diuretic/Dialysis
22
Q

What the defects of internal balance that cause hypokalemia?

A

Excess Inuslin

  • Catechol excess
  • Cell proliferation
  • Poor diabetic management
  • Aggressive lymphomas
  • Various causes
23
Q

What are the defects of external balance that cause hypokalemia?

A
  • Inadequate intake
  • GI/ Extrarenal losses
  • Renal losses (hypertenisve)
  • Renal losses (normotensive)
    -Anorexia, malnutrition
    -Diarrhea (NG tube= acid but NOT K)
  • Primary hyperaldosteronism (2=renal stenosis) Cushing, LIddle
    Diuretics, osmotic diuresis, RTA, Bartter, Gitelman
24
Q

What is the algorithm of hypokalemia?

A

1) Defect internal/external
2) Renal/Extrarenal losses
3) Hypertensive/normotensive

25
What are the clinical manifestations of hypokalemia?
Mild: Flat T-wave Mod: Prominent U-wave Severe: Depressed ST segment
26
What does hypokalemia do to skeletal muscle?
Weakness, paralysis, rhabdomyolysis
27
What does hypokalemia due to smooth muscles?
HTN, Ileus
28
What is Renal manifestations hypokalemia?
Nephrogenic DI
29
What is the treatment of hypokalemia?
``` NOT Urgent Treat underlying problem - Check Mag with Hypokalemia - Symptomatic: IV KCl, 10mEq= 0.1 increase - Asymptomatic: Oral K replacement ```