Hyperkalemia
*Should be treated as an emergency if K $
7.0meq/L, or at lower levels if cardiovascular or neuromuscular symptoms occur*
Elevator thoughts:
- Does the patient have renal failure?
- Is the patient receiving iv or po potassium supplements?
- Is the patient receiving hyperkalemic meds (spironolactone, triamterene, ace inhibitors)?
- Any illness associated with tissue breakdown (rhabdomyolisis, tumor lysis syndrome)?
- Is the lab result correct? If inconsistent with previous readings or unexpected, consider pseudohyperkalemia.
Database:
- New brady/tachyarrythmia?
- Neuromuscular- Muscle paralysis, weakness, tingling?
Plan:
- Review chart.
- Check recent labs, concentrating on previous potassium and creatinine levels.
- Obtain ECG, looking for peaked T waves and QRS widening.
- Consider repeating plasma potassium.
Treatment:
Acute hyperkalemia
- 5-10cc 10% calcium chloride or 10-20 cc 10% calcium gluconate iv over 5 minutes (for cardiac membrane stabilization).
- 50 grams iv dextrose/glucose with 15 u iv regular insulin (to induce transcellular shifts).
Subacute hyperkalemia
- Kayexalate 40g in 25-50cc 70% sorbitol q2-4 hrs; or rectally 50-100g in 200cc water as a retention enema q 2-4 hrs.
- Hemodialysis or peritoneal dialysis as definitive measure in renal failure.