Hyper K+ class slides

Question 1

K+

Answer 1

Major intracellular cation
Helps regulate pH
Major role in conducting nerve impulses and maintaining electrical excitability
Critical for neurological function

Question 2

Hypo K+

Answer 2

<2.5 normal 3.5-5

Question 3

Suspect hyper K+ in

Answer 3

Renal failure (most common)
Renal dialysis (pts develop hyper k+ quickly)
Pts taking k+ supplements

Question 4

Potential cause hyper K+

Answer 4

Psuedo hyper K+ (tourniquet on too long)
Acidosis
Heavy exercise
Insulin deficiency
Dig tox
K+ supplements/IV K+
Renal failure
K+ sparing diuretics
Crush injuries
MEdications (succ)
Hypoaldosteronism

Question 5

Dig tox

Answer 5

yellow vision

Question 6

ECG changes hyper K+

Answer 6

Not predictable

50% over K+ over 6mEq/L do not show on ECG changes

Question 7

Neuromuscular symptoms hyperk+

Answer 7

ECG changes/dysrhythmias
Weakness
Paraesthesia
Tremors
Areflexia
Respiratory failure
Ascending paralysis
GI

Question 8

ECG K+ 5.5-6mEq/L

Answer 8

Tented T waves

Question 9

ECG K+ 6-6.5mEq/L

Answer 9

Increasing PR and QT interval

Question 10

ECG K+ 6.5-7mEq/L

Answer 10

Flattened P waves widen and flatten, PR lengthens and P waves usually disappear

Question 11

ECG K+ 7-7.5 mEq/L

Answer 11

Widening of QRS and bizarre QRS morphology, high grade AV blocks, any conduction block, sinus brad or slow AF

Question 12

ECG K+ 7.5-8mEq/L

Answer 12

Merging of S and T waves, development of sine wave

Question 13

ECG K+ 8-10mEq/L

Answer 13

Sine wave, idioventricular complexes, VT appearance

Question 14

ECG K+ over 10mEq/L

Answer 14

PEA with bizarre wide complex rhythm VT/VF asystole

Question 15

Bicarb/calcium around

Answer 15

7mEq - QRS changes, blocks, brads, slow AF

Question 16

TXs

Answer 16

1. Membrane stabilization (priority, can all be done sequentially)
2. Shift potassium intracellularly
3. Remove excess potassium

Question 17

7 tx options for hyper K+

Answer 17

Calcium chloride - severe
Sodium bicarb - moderate to severe
Insulin/dextrose - moderate to severe
Ventolin - moderate to severe
Furosemide - moderate to severe
Kayexalate - mild to severe
Dialysis - pt dependent 
***Fluid TX - 10mL/kg

Question 18

Calcium Chloride

Answer 18

No effect on k+
Antagonizes toxic effects of K+ at myocardial membrane
Onset 1-3 minutes
Duration 30-50minutes

Question 19

Calcium Chloride indications

Answer 19

QRS complex, arrythmias are indications for CaCl
Peaked t waves alone are not
Usually given at 7.5mEq > range
Dose 8-16mg/kg single max dose of 1g over 10 minutes

Question 20

Insulin and dextrose

Answer 20

For moderate to severe hyper K+
Facilitates uptake of glucose into cell, brings K+ with it
Movement of glucose causes intracellular movement of K+ which decreases plasma K+
Onset 30 minutes, duration 4-6 hours

Question 21

Dextrose dose

Answer 21

0.5g/kg max 25g with 10 units humulin R IV/IO (no insulin repeat)
D50 repeat 0.5g/kg max 25 q 10-15 minutes
Check BGL each time

Question 22

Sodium Bicarb

Answer 22

Alkalinizing agent: Increases pH which results in temporary k+ shift from extracell to intracell, these agents enhance effectiveness of insulin in pts with acidosis
Onset 30 minutes
Duration 1-2 hours
Given in moderate & severe cases (6.5mEq/L - 10mEq/L(
Dose 50mEq IV/IO

Question 23

B2 agonists ventolin

Answer 23

Increase reuptake of k+ back into skeletal muscle
B2 effect increase glucose production in skeletal muscle and increase insulin production in pancreas
Onset 15-30 minutes
Duration 2-4 hours
Normal TX guidelines apply can be given prn

Question 24

Kayexalate (polystyrene sulfonate)

Answer 24

Exchanges sodium for K+ in the gut, decrease total amount of K+
Onset 1-2 hours duration 4-6 hours
30G PO/OG/NG or 50g PR no repeat dose

Question 25

Diuretics for hyperK+

Answer 25

Lasix, not K+ sparing diuretic, so essentially it will cause potassium loss through the kidney
Consider not in renal failure and for prehospital
Onset and duration varies
40-80mg SIVP/IO if pt is already on lasix then double dose

Question 26

Dialysis for hyperK+

Answer 26

Gold standard tx for pts with severe hyperK+

Onset minutes

Question 27

Hypokalemia

Answer 27

Most common electrolyte distrubance

Decrease in total body K+ often secondary to diuretic therapy

Question 28

Hypokalemia causes

Answer 28

Intracellular shifts + increase losses

• Inadequate intake
• GI losses - diarrhea, vomiting
• Diuretic Therapy (most common cause)
• Renal loss - diuretics
• Alkalosis
• Beta adrenergics

Question 29

Hypokalemia S&S CVS

Answer 29

HTN, Orthostatic hypotension, dysrhythmias (usually tachy)

ECG changes

Question 30

Neuromuscular S&S hypoK+

Answer 30

Weakness, Hyporeflexia, Parasthesia, paralysis

Question 31

HypoK+ TX

Answer 31

Oral replacement
Intravenous KCL (normally 10-20mEq/L)