The Curbsiders Internal Medicine Podcast REBOOT #137 Hyperkalemia Master Class with Joel Topf MD
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Jan 13, 2020 A nephrologist shares valuable insights on managing hyperkalemia, including common causes, using insulin safely, and the role of loop diuretics and fluids. They also discuss the effectiveness of fludrocortisone and answer questions about high potassium diets.
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Pseudo Hyperkalemia Trap
- Most common cause of high potassium is pseudo hyperkalemia from hemolysis or blood draw trauma.
- Check if elevated potassium value makes clinical sense before reacting urgently.
EKG Misses Many Hyperkalemias
- EKG sensitivity for detecting hyperkalemia is poor, missing 60% of severe cases.
- First symptom of hyperkalemia can indeed be sudden death, so don't rely solely on EKG changes.
Evaluate Urinary Obstruction
- For hyperkalemia, first check for urinary obstruction and relieve it if present.
- Use loop diuretics with saline and fludrocortisone for patients who make urine before resorting to binders.