Hyperkalemia: Difference between revisions
No edit summary |
|||
Line 22: | Line 22: | ||
A. | A. Increased potassium release from cells | ||
* 1. Metabolic Acidosis (drives potassium out of the cells (e.g. DKA)) | * 1. Pseudohyperkalemia | ||
* | ** a. Hemolysis of specimen | ||
** b. Leukocytosis and thrombocytosis | |||
*** 1. K+ increases by 0.15 meq for every 100,000 elevation in plt count | |||
* 2. Metabolic Acidosis (drives potassium out of the cells (e.g. DKA)) | |||
* 3. Cellular breakdown | |||
** a. Rhabdomyolysis | ** a. Rhabdomyolysis | ||
** b. Hemolysis | ** b. Hemolysis |
Revision as of 21:31, 1 March 2011
Background
High = >5.5meq/L High! = >6.5meq/L
Diagnosis
Always consider pseudohyperkalemia (e.g. from hemolysis)
ECG
6.5 - peaked Ts, inc PR, dec QT
7.5 - QRS widening, P flattening
8 - sine wave, v-fib, heart block
Differential Diagnosis
A. Increased potassium release from cells
- 1. Pseudohyperkalemia
- a. Hemolysis of specimen
- b. Leukocytosis and thrombocytosis
- 1. K+ increases by 0.15 meq for every 100,000 elevation in plt count
- 2. Metabolic Acidosis (drives potassium out of the cells (e.g. DKA))
- 3. Cellular breakdown
- a. Rhabdomyolysis
- b. Hemolysis
- c. Tumor lysis syndrome
- d. Crush
B. Increased total body potassium
- 1. Inadequate excretion
- a. Renal caused (acute or chronic renal failure-must have GFR<10)
- b. Mineralocorticoid deficiency or Addison's disease
- c. Drug-induced (potassium sparing diuretics [e.g., spironolactone] and ACE-inhibitors)
- 2. Excessive intake
- a. Diet, meds
- b. Blood transfusion
C. Pseudohyperkalemia
- 1. Hemolysis of the specimen
- 2. Prolonged period of tourniquets occlusion prior to blood draw
- 3. Thrombocytosis/leukocytosis
D. Misc
- 1. Sux, dig, B-blockers
Treatment
- 1. Calcium Gluconate 1 amp IV
- a. Give only if ECG changes/hypotension/or >7
- b. Can give multiple times
- c. Can also give CaCl 1 amp (but can lead to calcium toxicity)
- d. Caution in dig-toxic patients!
- e. Effect begins within minutes, lasts 30-60 minutes
- 2. Albuterol neb 10mg in 4mL saline over 10 min
- a. Peak effect within 90 min
- b. Lowers K ~ 0.5-1.5
- 3. Reg insulin 10 U IV with 1 amp D50W IV now, and 1 amp in 15 min
- a. Effect begins in 10-20 min, peaks at 30-60 min, lasts 4-6 hours
- b. Lowers K ~ 0.5 - 1.2
- 4. Bicarbonate
- a. Controversial
- b. NaBicarb 1 amp IV (over 5 min)
- 5. Kayexalate 30g PO or 50g PR (may cause hypernatremia and volume overload)
- 6. Dialyisis
Source
7/2/09 Adapted from Tintinalli, Donaldson, Pani