Electrolytes

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Author:
arzz
ID:
94533
Filename:
Electrolytes
Updated:
2011-07-19 11:31:19
Tags:
Hyperkalemia
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Description:
Condition and Treatment
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  1. Causes of Hyperkalemia

    (nl. K+ levels btw 3.5-5.0 mEq/L)
    • Acute kidney failure
    • Chronic kidney failure
    • Glomerulonephritis
    • Obstructive uropathy
    • Rejection of a kidney transplant
    • Addison's Dx (d/t lack of aldosterone)
  2. Other Causes of Hyperkalemia
    (mostly concurrent with kidney dx)
    • -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
  3. Other Causes cont:
    • Insulin deficiency, hyperglycemia, and hyperosmolality
    • Excercise
    • Increased Tissue Catabolism
    • Hypoaldosteronism
    • Digitalis Overdose (inhb. ATP pump)
  4. Other causes cont:
    • * Drugs - K+ Sparing Diuretics
    • - spironolactone
    • - amiloride
    • - triamterene
    • * ACEI's
    • * BB
  5. Sx. of Hyperkalemia
    • Usually none - unless serious
    • Irregular heartbeat (arrythmias)
    • Weak or absent pulse
    • Nausea/ Diarrhea
    • Muscle Weakness/Paralysis
  6. Signs and Tests
    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
  7. Acute Tx.
    • 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
  8. Long Term Tx.
    • Cation-exchange resin medications, such as sodium polystyrene sulfonate (Kayexalate) -- K+ binder
    • Depends on dx state
    • loop diuretics with CKD
  9. Complications
    • Arrhythmias
    • Cardiac arrest
    • Changes in nerve and muscle (neuromuscular) control
  10. Algorithm for Tx.
    - 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.

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