The Curbsiders Internal Medicine Podcast #137 Hyperkalemia Master Class with Joel Topf MD
Jan 28, 2019
Dr. Joel Topf, Chief of Nephrology at KashlakHospital, shares insightful tips on managing hyperkalemia. Topics discussed include common causes of hyperkalemia, the U-shaped curve of potassium levels and mortality, safe use of insulin, potassium binding resins and colonic necrosis, loop diuretics and fluids, fludrocortisone use, and high potassium diet and oral supplements.
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Pseudo-Hyperkalemia Importance
- Most common cause of elevated potassium is pseudo-hyperkalemia from hemolysis.
- Confirm hyperkalemia by repeating labs if the value doesn't make sense clinically.
Pseudo-Hyperkalemia Leads to Mistreatment
- A patient with white count of 300,000 had falsely elevated potassium leading to inappropriate dialysis.
- Actual potassium was low, showing dangers of acting on pseudo-hyperkalemia without confirmation.
EKG Insensitivity in Hyperkalemia
- EKG changes have poor sensitivity, missing over 60% of severe hyperkalemia cases.
- First symptom of hyperkalemia can be sudden death, so do not rely solely on EKG.