Hyperkalemia

Peaked T waves
  • 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)



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August 2nd 2010