Hyperkalemia

• Facts:
  Serum potassium > 5 mEq/L
• History / PE:
  Muscle weakness (earliest symptom)
  Intestinal colic
  Areflexia
  Nausea, vomiting
  Flaccid paralysis
  Parathesias
• Diagnosis:
  Tall, peaked T waves, wide QRS
  PR prolongation, loss of P waves
  
• Treatment:
  See pneumonic, plus...
  
  Sodium polystyrene sulfonate (potassium binding resin)
  Beta 2 agonists (albuterol)
• Complications:
  Ventricular fibrillation
  Cardiac arrest
• Pneumonic:
  C alcium gluconate (cardiac cell membrane stabilization)
  
  B icarbonate
  I nsulin
  G lucose (shift potassium back into cell)
  
  K ayexalate (removes potassium from body)
  
  D iuretics (loop) and D ialysis
• Associated With:
  Spurious
  Hemolysis of blood samples, fist clenching, extreme leukocytosis or thrombocytosis
  
  Decreased excretion
  Renal insufficiency, hypoaldosteronism, RTA Type IV , drugs (eg. spironolactone , triamterene, ACE inhibitors , trimethoprim, NSAIDs )
  
  Cellular shifts
  Tumor lysis syndrome , cell lysis, tissue injury, drugs (succinylchoine, digoxin , arginine, beta blockers)