Discussion on diagnosis methods and causes of hyperkalemia. Factors affecting kidneys and management of hyperkalemia. Strategies to lower potassium levels in critically ill patients. Management of hyperkalemia and stepped approach to caliuresis. Diuretic management of hyperkalemia.
EKG is crucial for determining immediate life-threatening hyperkalemia, but it cannot diagnose or risk stratify it.
Hyperkalemia can be caused by various factors such as pseudo hyperkalemia, iatrogenic factors, and renal failure, and each cause requires specific investigation.
Treatment approaches differ for mild to moderate hyperkalemia and severe hyperkalemia, with mild to moderate cases requiring addressing the cause and promoting potassium excretion, while severe cases require immediate heart stabilization and additional interventions.
Deep dives
Diagnosis of Hyperkalemia
Diagnosing hyperkalemia can be ambiguous, but the EKG is crucial for determining if it is immediately life-threatening. Common EKG findings include peaked T waves, widened QRS complex, smaller P wave, ventricular tachycardiomimic, and sine wave pattern. However, the EKG alone cannot diagnose or risk stratify hyperkalemia.
Causes of Hyperkalemia
Hyperkalemia can be caused by pseudo hyperkalemia (abnormalities occurring in the blood tube), iatrogenic factors (medications like ACE inhibitors, NSAIDs, or beta blockers), DKA and HHS, cellular lysis (homolysis, rheumatolysis, tumor lysis), renal failure, and dysfunction of the RAS system. Each cause has specific characteristics and should be investigated accordingly.
Treatment of Hyperkalemia
Treatment approaches differ for mild to moderate hyperkalemia and severe hyperkalemia. In mild to moderate cases, addressing the cause is important, along with promoting potassium excretion through diuresis using agents like furosemide and lactated ringer's solution. Severe hyperkalemia requires immediate stabilization of the heart with intravenous calcium, followed by intravenous insulin and beta agonists like subutumol. Additional interventions may include bicarbonate infusion and diuretic cocktail (chlorothiazide, loop diuretic, and acetazolamide). If medical therapies fail to lower potassium levels, dialysis may be necessary.
Pitfalls to Avoid
When treating hyperkalemia, it is important to avoid using K-exillate, hypertonic ampules of bicarbonate, and normal saline. Insulin should always be administered intravenously rather than subcutaneously. It is also vital to ensure that treatment promotes potassium excretion rather than relying solely on temporary measures like repeated rounds of insulin and glucose.
Conclusion
Hyperkalemia is a common electrolyte problem that requires careful diagnosis and appropriate treatment. Assessing EKG findings, investigating the underlying causes, and implementing effective treatment strategies can help manage hyperkalemia and prevent life-threatening complications.
Whether its your first day seeing patients, or your last, you need to have a solid approach to hyperK. Come check out the cast for all things hyperkalemic bombs, and a plea to STOP the madness with kayexalate.
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