HYPERKALEMIA

Question 1

MANAGEMENT

Answer 1

First step of potassium > 5.5 mEq:

Get stat ECG, Tele, IV Access

Management if ECG changes OR K > 6.5
Stabilize:
10 mL (1 amp) calcium chloride

Shift:
2 amp D50 + 10 U insulin
Monitor glucose q 30 min
Repeat k at 60 min

THEN
Salbutamol 8 puff

50 - 150 mEq IV NaHC03 if acidotic

Eliminate:
Insert foley
Hypovolemic - IV bolus normal saline, NO diuretic
Hypervolemic - furosemide 40 - 80 mg IV
Sodium polystyrene sulfonate (Keyexalate) 50 g PO

Management if potassium if NO ECG change AND K > 5.5 and < 6.5
Shift:
2 amp D50 + 10 U insulin
Monitor glucose q 30 min
Repeat k at 60 min

THEN
Salbutamol 8 puff

Eliminate:
Insert foley
Hypovolemic - IV bolus normal saline, NO diuretic
Hypervolemic - furosemide 40 - 80 mg IV
Sodium polystyrene sulfonate (Keyexalate) 50 g PO

Question 2

DOCUMENTATION

Answer 2

CLINICAL FEATURES
Nausea, Vomiting, and Diarrhea
Weakness
Paresthesias
Areflexia
Ascending Paralysis

ECG:
Prolong PR interval
Tall peaked T waves
Short QT interval
Flattening and eventual loss of P waves
QRS widening
Degradation of QRS into sinusoidal pattern
Tachycardia
Brady’s, AV blocks, and sinus pauses
Pseudo-ACS -> new BBB, ST changes
Sine Wave