Hyperkalemia

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Author:
bigfootedbertha
ID:
84388
Filename:
Hyperkalemia
Updated:
2011-05-07 14:14:08
Tags:
nephrology
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Description:
For my upcoming nephrology exam
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  1. What is hyperkalemia?
    K levels >5
  2. 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
  3. What are sx of hyperkalemia?
    Weakness, nausea, paresthesias, palpitations (though people are mostly asx)
  4. What EKG changes are associated with hyperkalemia?
    Peaked T waves ->increased PR interval->increased QRS width->sine wave pattern->PEA arrest
  5. 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
  6. 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)
  7. 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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