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Hyperkalemia

Dr Swapnil Pawar April 4, 2021 36


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    Hyperkalemia
    Dr Swapnil Pawar

Written by – Dr Andrew Lam 

Hyperkalemia

Causes of Hyperkalemia

Increased Intake

  • Excessive potassium dietary supplements
  • Excessive iatrogenic IV supplementation

Decreased Excretion

  • Acute or chronic renal failure/impairment
  • Hypoaldosteronism
  • Drugs (potassium sparing diuretics, ACEI’s, tacrolimus, cyclosporin)

Intercompartmental Shift

  • Pseudohyperkalemia (i.e. haemolysis from blood drawing) 
  • Acidosis
  • Insulin deficiency
  • Rapid Cell Lysis (i.e. rhabdomyolysis, cytotoxic therapy) 
  • Beta blockers

ECG changes in Hyperkalemia

Mild Changes (K > 5.5mmol/L)

  • Peaked T Waves

Moderate Changes (K > 6mmol/L)

  • P wave widening/flattening, followed by the disappearance
  • PR prolongation

Severe Changes (K > 7mmol/L)

  • Widened QRS interval
  • Sine-Wave Rhythm
  • Ultimately results in ventricular fibrillation or asystole

Management of Hyperkalemia

Hyperkalemic Emergency if any of the 3 criteria are met: 

  1. Clinical manifestations or ECG changes suggestive of hyperkalemia
  2. Serum potassium > 6.5s
  3. Serum potassium > 5.5 with renal impairment or ongoing tissue breakdown

In Hyperkalemic Emergency, immediate management requires:

  • Calcium Gluconate or Calcium Chloride (stabilises cardiac membrane) 
  • Insulin and glucose 
  • Bicarbonate (in patients who are concurrently acidotic)

This is given concurrently with therapy which removes potassium from the body:

  • Haemodialysis in patients with renal failure
  • Loop diuretics (i.e. frusemide)
  • Cation exchanger (i.e. resonium) 

References: 

Life in the Fast Lane. (2021). Hyperkalemia • LITFL • CCC. March 22, 2021, from, https://litfl.com/hyperkalaemia-ecg-library/

Mount, D.B., (2020). Causes and evaluation of hyperkalaemia in adults. UpToDate. Retrieved March 22, 2021, from https://www.uptodate.com.acs.hcn.com.au/contents/causes-and-evaluation-of-hyperkalemia-in-adults

Mount, D.B., (2020). Treatment and prevention of hyperkalaemia in adults. UpToDate. Retrieved March 22, 2021, from https://www.uptodate.com.acs.hcn.com.au/contents/treatment-and-prevention-of-hyperkalemia-in-adults

 

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