SHM's Clinical Quick Talks-Hyperkalemia

Pdf Summary
Hyperkalemia is a condition where potassium levels in the blood are elevated, particularly when the levels reach 7.5 mmol/L or higher. It is considered more dangerous than hypokalemia, which is when potassium levels are too low. The causes and work-up for hyperkalemia include ordering a complete blood count, basic metabolic panel, calcium and an electrocardiogram. It is important to confirm that the potassium elevation is real and not due to false elevation from lab abnormalities or other factors. Additional evaluations are performed to determine if there is a transcellular shift, increased intake, medication-related causes, decreased potassium excretion, or deficiency of mineralocorticoids or adrenal insufficiency.<br /><br />Symptoms of severe hyperkalemia may include decreased deep tendon reflexes or flaccid paralysis. Electrocardiogram findings progress from peaked T waves to loss of P waves, widened QRS, bradycardia, sine wave pattern, and even ventricular fibrillation. Associated symptoms are often related to the underlying cause of hyperkalemia, such as jaundice, myalgias, hypertension, heart failure, or hypotension.<br /><br />Treatment for hyperkalemia depends on factors such as the serum levels, rate of rise, symptoms, and cause. The mnemonic C BIG KD is used as a guide for treatment options. Calcium gluconate is given intravenously to stabilize the cardiac membrane. Beta agonists, such as nebulized albuterol, may be used. Insulin may be used to shift potassium back into cells. Glucose is often given alongside the insulin to prevent hypoglycemia. Kayexalate and Patiromer may be used to lower potassium levels, and diuretics or dialysis may be considered as a last resort for severe cases.<br /><br />Pseudohyperkalemia, which is a false elevation of potassium levels, is the most common cause of hyperkalemia, so it is important to repeat blood draws and use proper technique to ensure accurate diagnosis and treatment. Any changes in the electrocardiogram warrant a cardiology consultation and 24/7 monitoring until hyperkalemia is resolved. Early treatment is crucial as patients may be asymptomatic until potassium levels become dangerously high.
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Natalie Morris, Paul McMackin
Keywords
Hyperkalemia
potassium levels
elevated
hypokalemia
electrocardiogram
severe hyperkalemia
treatment
calcium gluconate
insulin
pseudohyperkalemia