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Hyperkalemia Flashcards

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1
Q

Define Hyperkalemia

A

Serum potassium>=5.5 mEq/l

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2
Q

What is considered mild, moderate and severe hyperkalemia

A

Mild: 55-5.9 mEq/L
Moderate: 6-6.4 mEq/L
Severe:>=6.5 mEq/l

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3
Q

Which body tissue has most potassium?

A

Skeletal muscles(75% of total body potassium)

Normal potassium range: 3.5-5.5 mEq/l(mmol/L)

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4
Q

What type of hyperkalemia occurs as a result of laboratory error?

A

Pseudohyperkalemia

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5
Q

List three common causes of pseudohyperkalemia.

A
  1. Hemolysis during blood drawing
  2. Hemolysis before lab analysis
  3. Hyperviscosity due to thrombocytosis, polycythemia Vera/leucocytosis
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6
Q

What are 4 common causes of hemolysis during blood drawing?

A
  1. Prolonged tourniquet on arm
  2. Small needles
  3. Excessive force to pull blood into the tube
  4. Excessive fist clenching
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7
Q

What are two common causes of hemolysis before lab analysis?

A
  1. Aggressive sample shaking
  2. Delay between blood drawing and analysis
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8
Q

What is the management of pseudohyperkalemia?

A

Retake the sample

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9
Q

What is the best initial test for hyperkalemia?

A

ECG-Shows hyperacute/peaked T waves with narrow bases in V2-4(earliest finding), broad QRS and prolonged PR interval

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10
Q

What is the earliest ECG finding of hyperkalemia?

A

Tall peaked T waves in V2-4 especially when they are taller than R waves(very sensitive sign)

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11
Q

What is the most dangerous EKG finding of Hyperkalemia?

A

Widening QRS complexes: It can merge with abnormal T waves forming sine wave appearing ventricular Tachycardia

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12
Q

List 4 EKG findings of hyperkalemia in ascending order.

A
  1. Tall peaked T waves
  2. PR prolongation
  3. QRS widens: Form sine wave V Tachycardia when they marge with abnormal T waves
  4. Decrease in P wave amplitude=>Nodal rhythm with absent p.waves
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13
Q

Which EKG findings is associated with potassium level of 8 mEq/L.and the complication of such level?

A

Sine wave pattern: merging of S waves with T waves

Become Ventricular fibrillation and cardiac arrest shortly afterwards

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14
Q

Which EKG finding is associated with potassium levels of 6.5-7.5 mEq/L?

A

Nodal rhythm with absent p waves

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15
Q

Tall peaked T waves on ECG are associated with what serum potassium levels?

A

5.5-6.5

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16
Q

List 4 ECG features of Hyperkalemia(K>=9).

A
  1. Asystole
  2. Ventricular fibrillation
  3. Pulse less electrical activity bizarre wide complexes
  4. Sine wave pattern(S and T waves join)
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17
Q

List three EKG findings of Hyperkalemia( K:7-8.9)

A
  1. Bradyarrhythmia
  2. Conduction blocks(BBB/fascicular blocks)
  3. Prolonged QRS interval with bizarre QRS morphology
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18
Q

What is the discharge criteria for hyperkalemia?

A

Normal serum potassium levels

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19
Q

Who to admit to the ICU with hyperkalemia?

A
  1. Persistent Hyperkalemia even after treatment
  2. Underlying condition mandate admission(severe renal failure)
  3. Cardiac toxicity occured
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20
Q

What guides the treatment of hyperkalemia?

A
  1. Serum potassium levels
  2. Renal function
  3. Presence/absence of ECG changes
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21
Q

What is the initial treatment for hyperkalemia?

A

10% Calcium carbonate/calcium chloride in 10 ml IV slowly over 10 minutes

NOTE: DO NOT LOWER TOTAL BODY POTASSIUM

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22
Q
A
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23
Q

What should be added to calcium carbonate/calcium chloride in the management of hyperkalemia first?

A

Dextrose 50% 100ml IV with insulin 10 units over 15-30 minutes

Followed by salbutamol 5 mg nebulized(Dilute in 4ml of NaCl 0.9%)

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24
Q

What is the adverse effect of insulin?

A

Hypoglycemia (look out for it)

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25
When is bicarbonate 50-100 ml of 8.4% added in the management of Hyperkalemia?
Only add if metabolic acidosis is present/occurs
26
Should bicarbonate be given in the same site as calcium carbonate?
Nope, they will precipitate
27
What are the commonest adverse effects of Salbutamol?
1. Tachyarrhythmias(Deadly) 2. Tremors 3. Flushing 4. Anxiety
28
What are the 3.commonest adverse effects of calcium carbonate?
1.Arrhythmias 2. Tissues necrosis if extravasated 3. Bradycardia NOTE: It does not lower potassium levels
29
What is the rate of potassium reduction by insulin+dextrose?
0.6-1 mmol/L/hour
30
Which one between calcium chloride and calcium carbonate have more Calcium ions?
calcium gluconate = 2.2mmol of Ca2+ in 10mL calcium chloride = 6.8mmol of Ca2+ in 10mL
31
Which one between calcium chloride and calcium carbonate is more likely to lead to tissue necrosis?
Calcium chloride: It has more calcium ions calcium gluconate = 2.2mmol of Ca2+ in 10mL calcium chloride = 6.8mmol of Ca2+ in 10mL
32
List three exogenous sources of potassium that commonly lead to Hyperkalemia
1. Massive blood transfusion 2. High dose potassium penicillin 3. Poisoning/ingestion
33
List 6 causes of hyperkalemia due to reduction in excretion.
1. Decreased glomerular filtration rate(Renal Injury) 2. Heart failure 3. Obstructive uropathy 4. Low aldosterone level due to drenal insufficiency (Addison disease)and Low renin level 5. Type 4 renal tubular acidosis 6. edications that inhibit Na-K ATPase in the distal nephron
34
What is the most common cause of Hyperkalemia?
Spurious elevation
35
36
37
What is most.common cause of true hyperkalemia?
Chronic Kidney failure
38
List 5 common drugs that cause hyperkalemia
1. Nonsteroidal anti-inflammatory drugs, 2. Potassium-sparing diuretics, 3. digoxin, 4. angiotensin-converting enzyme inhibitors 5. administration of intravenous potassium chloride
39
List 5 common causes of hyperkalemia through cell death.
1. Rhabdomyolysis 2. Hemolysis(Intravascular) 3. Tumour lysis syndrome 4. Crush injuries 5. Burns
40
Much less common causes of hyperkalaemia include adrenal insufficiency, hyperkalaemic periodic paralysis, and hematologic malignancies.
JUST MEMORIZE
41
Most patients with hyperkalemia are symptomatic.
False. Only symptomatic when it is severe
42
State three neurological exam findings for hyperkalemia
1. Decreased deep tendon reflexes 2. Decreased power 3. Intact sensation
43
What Physical exam findings are typical for hyperkalemia?
Bradycardia or irregular rhythm with premature contractions
44
State the typical presentation of hyperkalemia.
Muscle cramps, paresthesias, and weakness that can progress to a flaccid paralysis Patients may experience palpitations or generalized fatigue and malaise.
45
46
Name 4 drugs that lead to reduction in aldosterone release/activity that leads to Hyperkalemia
1. ACE inhibitors 2. Angiotensin receptor blockers 3. Aldosterone inhibitors: Spironolactone and eplerenone 4. Potassium-sparing diuretics:Triamtene and Amilorode
47
Which cause of metabolic acidosis is associated with hyperkalemia and hyporenin hypoaldosteroiism
Renal tubular acidosis type 4
48
Give the names of three drugs that lead to Hyperkalemia through increased release of K.
1. Beta blockers 2. Digoxin 3. Heparin
49
Four.coon clinical features of Hyperkalemia
1. Muscle weakness 2. Cardiac rhythm disorder 3. Flaccid paralysis 4. Paralytic ileus
50
Is hyperkalemia associated with seizures
Nope
51
List EKG findings of severe Hyperkalemia.
1. Tall peaked T waves 2. PR prolongation 3. Wide QRS
52
Can you give calcium carbonate if the EVG is normal?
Nope
53
In addition to the initial management of lowering potassium what other options are available?
1. Kayoxelate 2. Dialysis 3. Loop diuretic furosemide 1-2 mg 4. Oral potassium binders(parieomer or zirconium) for long term therapy
54
If there are no EVG changes, state how you would treat hyperkalemia?
Insulin and dextrose 50% in 100 ml You can add furosemide and Kayexalate
55
56
List causes of hyperkalemia due to shift of potassium out of the cell.
1. Haemolysis (Rhabdomyolysis; Tumour lysis syndrome and Haematoma reabsorption) 2. Medications that inhibit Na-K ATPase pump 3. Insulin deficiency including Diabetes mellitus and Prolonged fasting 4. Hypertonicity including Hyperglycaemia and hypernatremia 5. Acidosis 6. Hyperkalemia periodic paralysis (mutation of skeletal muscle Na-K pump)
57
Why is hemodialysis the best for hyperkalemia
1. Can remove 25-40mmol/hr -> 1mmol/L/hr 2. Faster if increase blood flow rate, dialysis flow rate, low K+ concentration in dialysate, high bicarbonate concentration
58
Can prolonged immobility and/or seizures cause Hyperkalemia
Yes
59
When can someone get Hyperkalemia as a result of increased dietary intake?
In the presence of renal failure/dysfunction Note: If kidney function is normal, it is almost impossible to ingest potassium faster than the kidney can excrete it
60
Is the rate of potassium excretion higher than the rate of potassium absorption by the gut?
Yes
61
Outline how beta blockers lead to Hyperkalemia.
Normal Na/K ATPase activity lowers blood potassium. Beta-blockers decrease the activity of the sodium/potassium ATPase. When you inhibit Na/K ATPase with a beta-blocker, potassium levels can go up
62
How does heparin cause Hyperkalemia?
By inhibiting aldosterone.
63
What is the first line treatment of Hyperkalemia without.EKG changes?
IV insulin and dextrose
64
What are the indications for bicarbonate in management of Hyperkalemia?
1. Acidosis 2. Rhabdomyolysis 3. Hemolysis 4. Anything that alkalanize the urine
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