Hyperkalemia
Considerations
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Emergency situation with potential for life threatening arrhythmias, cardiac arrest
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Etiology:
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Shift:
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Metabolic or respiratory acidosis, diabetic ketoacidosis
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Digoxin toxicity
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Total body excess:
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Rhabdomyolysis (malignant hyperthermia, crush injuries, burns)
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Post cardiopulmonary bypass
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Iatrogenic (IV or oral)
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Hemolysis
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Tumor lysis
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Transfusion (massive transfusion, old packed red blood cells)
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Renal failure
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Hypoaldosteronism
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Addison's
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Drugs (succinylcholine, ACE inhibitors, beta blockers, spironolactone, NSAIDs, cyclosporin)
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Systemic effects
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Arrhythmias
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Muscle weakness
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Drug interactions
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Succinylcholine contraindicated
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Non-depolarizer muscle relaxants: resistance
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Management
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Stabilize myocardium:
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Calcium gluconate 100 mg/kg
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Shift potassium intracellularly:
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Insulin 0.1 units/kg + Glucose 0.5-1 g/kg (25 g for every 10 U insulin)
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Sodium bicarbonate 1 mEq/kg
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Ventolin 5-10 mg via nebulizer or 5 mcg/kg IV
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Hyperventilation
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Epinephrine
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Eliminate potassium:
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Furosemide 20-40mg IV
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Kayexalate 30 g PR or PO
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Dialysis
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ECG changes
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Mild (5.5-6.5 mEq/L): peaked T waves, prolonged PR interval (1st degree AV block)
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Moderate (6.5-8 mEq/L): loss of P wave, prolonged QRS, ST segment elevation, ectopic beats/escape rhythms
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Severe (>8.0 mEq/L): progressive widening of QRS, bundle branch blocks, fascicular blocks, sine wave, ventricular fibrillation, asystole