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Internal Med > Hyperkalemia/Hypokalemia > Flashcards

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
Q

What are the clinical manifestations of hypokalemia?

A

Mild: Flat T-wave
Mod: Prominent U-wave
Severe: Depressed ST segment

26
Q

What does hypokalemia do to skeletal muscle?

A

Weakness, paralysis, rhabdomyolysis

27
Q

What does hypokalemia due to smooth muscles?

A

HTN, Ileus

28
Q

What is Renal manifestations hypokalemia?

A

Nephrogenic DI

29
Q

What is the treatment of hypokalemia?

A 
NOT Urgent
Treat underlying problem
- Check Mag with Hypokalemia
- Symptomatic: IV KCl, 10mEq= 0.1 increase
- Asymptomatic: Oral K replacement

Internal Med (4 decks)

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