What is hyperkalemia?
Potassium level that exceeds 5.0 mEq/L
What is pseudohyperkalemia?
A condition that can occur due to methods of blood specimen collection and cell lysis; if an increased serum value is obtained in the absence of clinical symptoms, the specimen should be redrawn and evaluated.
What are three basic causes of hyperkalemia?
Excessive potassium intake
Decreased potassium excretion
Movement of potassium from the intracellular fluid to the extracellular fluid.
What causes excessive potassium intake? (2)
Overingestion of potassium-containing foods or medications, such as potassium chloride or salt substitutes.
Rapid infusion of potassium-containing IV solutions.
What causes decreased potassium excretion? (3)
Potassium-retaining diuretics
Kidney disease
Adrenal insufficiency, such as in Addison’s disease
What causes movement of potassium from the intracellular fluid to the extracellular fluid? (4)
Tissue damage
Acidosis
Hyperuricemia
Hypercatabolism
What are the cardiovascular signs and symptoms of hyperkalemia? (2)
Slow, weak, irregular heart rate
Decreased blood pressure
What are the respiratory signs and symptoms of hyperkalemia?
Profound weakness of the skeletal muscles leading to respiratory failure.
What are the early neuromuscular signs and symptoms of hyperkalemia? (3)
Muscle twitches
Cramps
Paresthesias (tingling and burning followed by numbness in the hands and feet and around the mouth)
What are the late neuromuscular signs and symptoms of hyperkalemia? (2)
Profound weakness
Ascending flaccid paralysis in the arms and legs (trunk, head, and respiratory muscles become affected when the serum potassium level reaches a lethal level)
What are the gastrointestinal signs and symptoms of hyperkalemia? (2)
Increased motility, hyperactive bowel sounds
Diarrhea
What are the laboratory findings that indicate hyperkalemia?
Serum potassium level that exceeds 5.0 mEq/L
ECG changes
What are the ECG changes that indicate hyperkalemia?
Tall peaked T waves, flat P waves, widened QRS complexes, and prolonged PR intervals
What systems should the nurse monitor in a patient with hyperkalemia?
Cardio, resp, neuromuscular, renal, and gastro
What medications may be administered to the patient with hyperkalemia if renal function is not impaired?
Potassium excreting diuretics
What medication may be administered to the patient with hyperkalemia if renal function is impaired? How does this medication work?
Sodium polysystrene sulfonate (Kayexalate) - a cation-exchange resin that promotes gastrointestinal sodium absorption and potassium excretion
What treatment might the patient need if potassium levels are extremely high?
Dialysis
What might be given intravenously if hyperkalemia is severe to avert myocardial excitability?
IV calcium
What is used to move excess potassium into the cells?
IV administration of hypertonic glucose with regular insulin
