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What is hyperkalemia?
K levels >5
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What causes hyperkalemia?
-Transcellular shifts
-Decreased GFR
-Decreased K excretion
- Transcellular: acidosis, massive cellular necrosis (rhabdo, tumor lysis syndrome), beta blockers
- Decreased GFR: oliguric/anuric acute renal failure, missed dialysis with ESRD
- -Decreased K excretion: hypoaldosteronism, Bactrim, K sparing diuretics
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What are sx of hyperkalemia?
Weakness, nausea, paresthesias, palpitations (though people are mostly asx)
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What EKG changes are associated with hyperkalemia?
Peaked T waves ->increased PR interval->increased QRS width->sine wave pattern->PEA arrest
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What are basic tx guidlines of hyperkalemia?
- Rule out pseudohyperkalemia from bad lab draw (due to hemolysis or K in IV)
- Rule out transcellular shift
- Always get an EKG
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How do you tx hyperkalemia with no EKG changes?
- First option: Lasix 20-40 mg IV x 1
- Second option: Kayexalate 20-45g PO or PR x 1 (binds K in gut, so make sure gut is working: no ileus, BO)
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How do you tx hyperkalemia with EKG changes?
- First: Calcium gluconate 10%, 1 amp IV x1 to stabilize cardiac cell membrane
- Next: give Insulin 10 units of regular IV x 1 with glucose (D50 1 amp IVx1)-->insulin drives K into cells
- Option: Bicarb 1 or 2 amps IV x 1
- Option: Albuterol 10-15 mg nebx1
- Last resort: dialysis
- ALWAYS: give lasix and kaoxalate
- Recheck K to ensure it's going down
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