Management of Hyperkalemia


- Discussion:
    - diff dx:
    - physical exam:
            - neuromuscular: weakness, paresthesia, depressed tendon reflexes;
    - assess severity:
            - K > 8.0 mmol/L, EKG w/ more than peaked T waves alone, or if cause is not immediately remediable;
            - hyperkalemia may worsen CHF, DKA, acute dehydration, extensive tissue breakdown (burns), or adrenal insufficiency;

- Acute HyperK > 6.5:
    - monitoring and precautions:
          - EKG monitoring, if K > 6.5 mmol/L;
          - caution if pt is on digoxin (may precipitate ventricular dysrhythmia);
          - monitor K+ concentration every 1-2 hrs until it is < 6.5 mmol/L;
    - medications:
          - Ca gluconate 5-10ml 10% IV over 5 min;
                  - will antagonize cardiac & neuromuscular effects of hyperK, effects will last for 1 hr, will not reduce K+ level;
          - HCO3:
                  - 1amp = 7.5% = 44.6mEq in 5min
                  - effects are immediate and lasts for 1-2 hrs;
          - glucose:
                  - D50W: 50 ml IV followed by regular insulin 5-10 units IV will shift K+ from the ECF to the ICF;
                  - its effects are immediate and lasts for 1-2 hrs; or try:
                  - 1 amp of glucose (25gm in 5min) w/ Reg insulin 10 units IV;
          - glucose-insulin-HCO3 "cocktail":
                  - D10W 1000 ml w/ 3 ampules of NaHCO3 & 20 units of regular insulin at 75 ml/hr until more definite measures are taken;
          - kayexalate:
                  - 15-30 gm (4-8 tsp) in 50 to 100 ml of 20% sorbitol PO q3-4 hrs, or 50 gm in 200 ml 20% sorbitol or D20W PR by retention enema for 30-60 min q4hr;
                  - kayexalate: 1gm resin rids 1mEq K; 1teasp = 3.5gm;
                  - careful with CHF, HTN, constipation;
                  - may also try 15-30gm Kay w/ 50-100ml 20%Sorbitol or 20% DW;
    - hemodialysis:
          - if other measure fail or if the patient is in acute or chronic renal failure



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, September 5, 2012 3:27 pm