Hyperkalemia: Difference between revisions

Latest revision as of 13:27, 14 June 2021

Background

Serum potassium above 5mmol/L

Pathophysiology

98% of total body potassium is intracellular
Gradient maintained by
- Na-K antiporters (3Na:2K)
- H-K antiporter
Normally excreted in the urine
- Aldosterone stimulates ENAC channels and Na-K channels

Clinical Manifestations

Arrythmias
- Bradycardia
- Asystole
Muscle paralysis (tetany)

Differential Diagnosis

Decreased excretion
- Decreased aldosterone
  - Primary adrenal insufficiency
  - Secondary adrenal insufficiency
- Decreased aldosterone responsiveness
  - Spironolactone
  - Amiloride
- Decreased sodium delivery to kidneys
Increased intake
- Iatrogenic
Shifts
- Rhabdomyolysis
- Tumour lysis syndrome
- Acidosis
- Drugs
- Hemolysis
- Anemia
- Increased plasma osmolality
Factitious
- Hemolysed samples
- Increased white cell count
  - Chronic lymphocytic leukemia
- Increased platelets

Management

EKG
Repeat serum potassium
Pharmacologic treatment indicated if EKG changes
Stabilize
- Calcium gluconate 1g IV push q30min prn EKG changes
  - Lasts 30-60 minutes
  - Repeat EKG in 30 minutes, then can give another 1g
Shift
- Insulin R 10 unites in 1 amp D50W
- Albuterol 8-10 puffs
- Bicarbonate
  - No evidence of benefit and increases serum sodium
Excrete
- Kayexalate and lactulose
  - Takes 2-3 days to work
- Normal saline
- If not hypovolemic and not on ACEi or ARB, furosemide
- If refractory to medical management, dialysis

@@ Line 1: / Line 1: @@
-== Definition ==
+== Background ==
 * Serum potassium above 5mmol/L
-== Pathophysiology ==
+=== Pathophysiology ===
 * 98% of total body potassium is intracellular
@@ Line 11: / Line 11: @@
 * Normally excreted in the urine
 ** Aldosterone stimulates ENAC channels and Na-K channels
+== Clinical Manifestations ==
+* Arrythmias
+** [[Bradycardia]]
+** [[Asystole]]
+* Muscle paralysis ([[tetany]])
 == Differential Diagnosis ==
@@ Line 16: / Line 22: @@
 * Decreased excretion
 ** Decreased aldosterone
-*** Primary adrenal insufficiency
+*** [[Primary adrenal insufficiency]]
 *** Secondary adrenal insufficiency
-**** ACE inhibitors
+**** [[ACE inhibitors]]
-**** Angiotensin-receptor blockers
+**** [[Angiotensin receptor blockers]]
-**** Renin inhibitors
+**** [[Renin inhibitors]]
-**** NSAIDs
+**** [[NSAIDs]]
-**** Congenital adrenal hyperplasia
+**** [[Congenital adrenal hyperplasia]]
 ** Decreased aldosterone responsiveness
-*** Spironolactone
+*** [[Spironolactone]]
-*** Amiloride
+*** [[Amiloride]]
 ** Decreased sodium delivery to kidneys
-*** Hypovolemia
+*** [[Hypovolemia]]
-*** Heart failure
+*** [[Heart failure]]
-*** Cirrhosis
+*** [[Cirrhosis]]
-*** Nephrotic syndrome
+*** [[Nephrotic syndrome]]
 * Increased intake
 ** Iatrogenic
 * Shifts
-** Rhabdomyolysis
+** [[Rhabdomyolysis]]
-** Tumour lysis syndrome
+** [[Tumour lysis syndrome]]
-** Acidosis
+** [[Acidosis]]
 ** Drugs
-*** Hypoinsulinemia
+*** [[Hypoinsulinemia]]
-*** Beta blockers
+*** [[Beta blockers]]
-*** Digoxin
+*** [[Digoxin]]
-*** Succinylcholine
+*** [[Succinylcholine]]
-** Hemolysis
+** [[Hemolysis]]
-** Anemia
+** [[Anemia]]
 ** Increased plasma osmolality
 * Factitious
 ** Hemolysed samples
 ** Increased white cell count
-*** Chronic lymphocytic leukemia
+*** [[Chronic lymphocytic leukemia]]
 ** Increased platelets
-== Complications ==
-* Arrythmias
-** Bradycardia
-** Asystole
-* Muscle paralysis (tetany)
 == Management ==