Electrolytes

• Acute kidney failure
• Chronic kidney failure
• Glomerulonephritis
• Obstructive uropathy
• Rejection of a kidney transplant
• Addison's Dx (d/t lack of aldosterone)

• -Acidosis - moves K+ from inside of cell to outside in the bloodstream.
• -Tissue Injury - burns, hemolytic conditions, GI bleeding, Rhabdo, Surgery, Trauma, Tumors.
• -Salt Substitutes
• -High K+ intake

• Insulin deficiency, hyperglycemia, and hyperosmolality
• Excercise
• Increased Tissue Catabolism
• Hypoaldosteronism
• Digitalis Overdose (inhb. ATP pump)

• * Drugs - K+ Sparing Diuretics
• - spironolactone
• - amiloride
• - triamterene
• * ACEI's
• * BB

• Usually none - unless serious
• Irregular heartbeat (arrythmias)
• Weak or absent pulse
• Nausea/ Diarrhea
• Muscle Weakness/Paralysis

ECG may show potentially dangerous arrhythmias:

• *Heart block that may become a complete heart block
• *Slower than normal heartbeat (bradycardia) that progressively slows
• *Ventricular fibrillation
• *Pulse may be slow or irregular

• Dialysis -- to reduce total body potassium levels, esp if kidney function is compromised
• Diuretics
• Intravenous calcium -- to temporarily treat muscle and heart effects of hyperkalemia
• Intravenous glucose and insulin -- to reverse severe symptoms
• Sodium bicarbonate -- to reverse hyperkalemia caused by acidosis
• B2agonists

• Cation-exchange resin medications, such as sodium polystyrene sulfonate (Kayexalate) -- K+ binder
• Depends on dx state
• loop diuretics with CKD

• Arrhythmias
• Cardiac arrest
• Changes in nerve and muscle (neuromuscular) control

- Is life-threatening hyperkalemia present? (ECG changes? Serum K > 6.5 mEq/L? High-risk as renal failure, receiving dialysis, causative medications?)

A. If No (Life-threatening hyperkalemia is not present) --> Resin exchange with laxative, loop diuretic as furosemide, dialysis

• *Kayexalate (Na Polystyrene Sulfonate) 30 gm in 100 cc 20% sorbitol PO q3-4h. Kayexalate 50 gm in 200 cc 20% sorbitol retention enema 30- 60 min q 4- 6h (decreased 0.5-1 meqK)
• *Furosemide (Lasix) 40-80-160 mg IV
• *Dialysis

• B. If Yes (life-threatening hyperkalemia is present)-->
• -Step 1: Stabilize the myocardium: (IV Calcium infusion)

• *IV Calcium Chloride (27.2 mg/dL calcium) or Calcium gluconate (8.8 mg/dL calcium) 10 mL (1 amp) of 10% solution (500-1000 mg) IV infusion over 2-3 minutes.* Be extra careful when using calcium infusion in patients with concurrent digitalis toxicity, it could worsen brady-arrhythmia and potentially cause cardiac arrest; use EKG monitor. - for slow infusion, may give the calcium solution in 250 mL D5W and given over 30 minutes.
• -Step 2: Shift potassium into cells: (IV glucose +/- insulin +/- Na bicarbonate; Albuterol nebulizer Rx or IV infusion)

IV 25 - 50 gm of glucose (25-50 g = 1-2 ampules of 50% dextrose D50W or 250-500 mL of D10W solution) +/- IV Regular insulin 10 units - May add Na HCO3 7.5% 50 cc amp 1 -2 amp in the setting of substandial metabolic acidosis (bicarbonate <22 mEq/L)

• -Albuterol nebulizer Rx can be administered at a dosage of 10 to 20 mg in 4 ml of saline by nasal inhalation over 10 minutes or by a 0.5 mg I.V. infusion.
• - Beta-agonists decrease plasma potassium levels. Albuterol can be given via a nebulizer (10-20 mg in 4 mL of saline) or via IV infusion (0.5mg). The dosages of B-agonists administered in this setting are relatively high, ranging from 4 to 8 times that recommended for Rx of an acute asthma exacerbation).
• The major adverse effects are tremor, tachycardia, anxiety, and flushing.

• -Step 3: Enhance elimination of potassium: (Kayexalte, Lasix, Dialysis)
• Resin exchange with laxative: Kayexalate (Na Polystyrene Sulfonate) 30 gm in 100 cc 20% sorbitol PO q3-4h. Kayexalate 50 gm in 200 cc 20% sorbitol retention enema 30- 60 min q 4- 6h (decreased 0.5-1 meqK)
• Loop diuretic as furosemide (Lasix) 40-80-160 mg IV
• Hemodialysis - It is the Rx of choice for life-threatening hyperkalemia that is refractory to medical management. It may decrease the serum K level by 1.0 - 1.5 mEq/L for each hour of dialysis.