Hyperkalemia management
Posted by dkwinter

Source: Academic Life in Emergency Medicine

Potassium regulation

1. Internal K shift: modulated by insulin, catecholamines, acid-base status

2. Total body K elimination: By kidney (95%) and gut (5%)


Adverse effects of hyperkalemia

1. Cardiac: Peaked T, wide QRS, loss of P wave, sine wave; although Vfib may be first cardiac manifestation.

2. Neuromuscular:  Paresthesias, weakness

3. Metabolic: Mild hyperchloremic metabolic acidosis


Goals of hyperkalemia treatment

1. Cardiac membrane stabilization

   * Calcium: Reduces threshold potential in myocytes; check to be sure not on digoxin

   * Hypertonic saline: Only for severe hyponatremia in setting of hyperkalemia


2. K redistribution

   * Insulin: Drives K intracellularly and drops serum K level by 0.6 mmol/L

   * Beta-agonist: Drives K intracellularly and 10 mg albuterol drops serum K level by 0.6 mmol/L (20 mg --> K drops by 1 mmol/L); effective in only 60% of patients


3.  K elimination via kidney/gut

   * Bicarbonate: drives K out at distal nephron; best as infusion x 4-6 hrs

   * Loop diuretic

   * Exchange resin (sodium polystyrene sulfonate) – case reports of colonic necrosis; constipating med and so combined with sorbitol; minimal benefit.