Hyperkalemia

Normal : 3.5 – 5.5 mmol/L

>6.5mmol/L is an emergency and needs urgent treatment.

s/s – fast irregular pulse, palpitations, chest pain, weakness and light-headness,  parenthesis, areflexia, & paralysis

ECG – tall tented T waves >> small/ flat P waves; increased PR interval >> Widening of QRS (eventually may have sinusoidal pattern) and VF/VT

Causes

Pseudohyperkalemia/ artefactual results

  • Hemolysis (in laboratory tube) most common
  • Thrombocytosis
  • Leukocytosis
  • Venipuncture technique (ie, ischemic blood draw from prolonged tourniquet application)
  • contamination with potassium EDTA
  • delayed analysis

Redistribution

  • Acidosis
  • Insulin deficiency
  • Drugs: Beta-blocker, Digoxin (a/c overdose), Succinylcholine or Suxamethonium, Arginine hydrochloride
  • Hyperkalemic familial periodic paralysis
  • Burns

Excessive endogenous potassium load

  • Hemolysis
  • Rhabdomyolysis
  • Internal hemorrhage
  • Tumor lysis

Excessive exogenous potassium load

  • Parenteral administration/ Blood transfusion
  • High dose Penicillin (1.7 meq K+ per 1 Million Units)
  • Excess in diet
  • Potassium supplements
  • Salt substitutes

Diminished potassium excretion

  • Decreased glomerular filtration rate (eg, acute or end-stage chronic renal failure)
  • Decreased mineralocorticoid activity
  • Defect in tubular secretion (eg, renal tubular acidosis II and IV)
  • Drugs (eg, NSAIDs, ACE-i, heparin, cyclosporine, potassium-sparing diuretics)

Laboratory error

Management Protocol

See the link below:

http://www.fpnotebook.com/mobile/renal/potassium/hyprklmmngmnt.htm

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