Nephrology

Question 1

what does an EKG look like of someone with hyperkalemia?

Answer 1

everything widens (prolonged PR + wide QRS) + peaked T waves

extreme cases is sine wave. theyre pretty much dead if you find this tho.

Question 2

3 phases of treatment of acute unstable hyper K+. which meds do you use for each stage

Answer 2

1. stabilize myocardium = IV calcium (Ca gluconate)
2. Temperorize = MOC is insulin + glucose, or can use bicarbonate
3. decrease total body K+ with non K+ sparing diuretics, or Kavexalate.
   later on can use dialysis when pt is stable

Question 3

when replacing K+ if pt is hypokalemic, PO is preferred, but if by IV, what rate do you replenish?

Answer 3

peripheral IV <10mEq/hr b/c it burns their arm
central IV <20mEq/hr or else they can start to have hyperkalemic sx

btw 10mEq -> raise K+ 0.1 about

Question 4

trying to replenish K+ in a hypokalemic patient but it just wont go up! what to check?

Answer 4

Magnesium level.

if low, need to replenish Mg. then K+ can be corrected