{"id":2606,"date":"2010-02-02T21:03:30","date_gmt":"2010-02-03T02:03:30","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=2606"},"modified":"2013-03-07T22:13:38","modified_gmt":"2013-03-08T03:13:38","slug":"hyperkalemia","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2010\/02\/hyperkalemia\/","title":{"rendered":"Hyperkalemia"},"content":{"rendered":"<p><script type=\"text\/javascript\">\/\/ <![CDATA[\ngoogle_ad_client = \"ca-pub-3355182385430819\"; \/* test-200x90 *\/ google_ad_slot = \"2854171204\"; google_ad_width = 200; google_ad_height = 40;\n\/\/ ]]><\/script><br \/>\n<script type=\"text\/javascript\" src=\"http:\/\/pagead2.googlesyndication.com\/pagead\/show_ads.js\">\/\/ <![CDATA[\n\n\/\/ ]]><\/script><\/p>\n<h4>Pathophysiology of Hyperkalemia<\/h4>\n<p><strong>1) <\/strong>hyperkalemia is\u00c2\u00a0plasma K+ &gt; 5.0 mmol\/L (if &gt; 7.5 mmol\/L, becomes life threatening<br \/>\n<strong>2)<\/strong> caused by increased release from cells (intravascular hemolysis, tumor lysis syndrome, rhabdomyolysis), decreased clearance by kidney due to acute or chronic kidney failure, excess intake (often iatrogenic)<\/p>\n<h4>Signs and Symptoms<\/h4>\n<p><strong>1)<\/strong> weakness up to flaccid paralysis<br \/>\n<strong> 2)<\/strong> cardiac excitablity<\/p>\n<h4>Characteristic Test Findings<\/h4>\n<p><em>EKG<\/em><\/p>\n<p><strong>1)<\/strong> peaked T waves are characteristic of hyperkalemia<br \/>\n<strong>2)<\/strong> prolonged PR interval<br \/>\n<strong>3)<\/strong> widening of QRS<br \/>\n<strong>4)<\/strong> absent P waves<br \/>\n<strong>5)<\/strong> ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation)<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-2761\" title=\"hyperkalemia\" alt=\"hyperkalemia\" src=\"http:\/\/insidesurgery.com\/wp-content\/uploads\/2010\/02\/hyperkalemia.jpg\" width=\"269\" height=\"401\" \/><\/p>\n<h4>Associated Conditions<\/h4>\n<p><strong>1)<\/strong> metabolic acidosis (due to intracellular buffering of H+)<br \/>\n<strong>2)<\/strong> hyperglycemia<br \/>\n<strong>3)<\/strong> digitalis toxicity<br \/>\n<strong>4)<\/strong> hemolysis<br \/>\n<strong>5)<\/strong> hyperaldosteronism (<a href=\"http:\/\/en.wikipedia.org\/wiki\/Conn%27s_syndrome\">Conn&#8217;s disease<\/a>)<br \/>\n<strong>6)<\/strong> Addison&#8217;s disease<br \/>\n<strong>7)<\/strong> K+ sparing diuretics (spironolactone)<br \/>\n<strong>8)<\/strong> ACE inhibitors<br \/>\n<strong>9)<\/strong> NSAIDs<br \/>\n<strong>10)<\/strong> cyclosporine<br \/>\n<strong>11)<\/strong> trimethoprim<br \/>\n<strong>12)<\/strong> pentamidine<\/p>\n<h4>Biochemistry<\/h4>\n<p>hyperkalemia partially depolarizes cardiac cell membranes<\/p>\n<h4>Treatment<\/h4>\n<p><strong>1)<\/strong> aim is to shift K+ into cells and promote K+ loss<br \/>\n<strong>2)<\/strong> 25-50 g of Kayexalate (sodium polystyrene sulfonate) with 100 mL of 20% sorbitol by mouth or enema (cation exchange agent)<br \/>\n<strong>3)<\/strong> 1 ampute of calcium gluconate (decreases membrane excitability), 50 g IV glucose, and 10-20 units of regular insuline IV (causes K+ to shift into cells)<br \/>\n<strong>4)<\/strong> beta2-adrenergic agonists via IV of nebulizer (effect lasts 2-4 h)<br \/>\n<strong>5)<\/strong>\u00c2\u00a0extremed hyperkalemia is treated with dialysis with low K+ dialysate<br \/>\n<strong>6)<\/strong> alkali therapy with 3 ampules of NaHCO3 per liter IV<\/p>\n<h4>Tips for USMLE<\/h4>\n<p>if question mentions peaked T waves on EKG, think hyperkalemia or anterior cardiac ischemia<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Pathophysiology of Hyperkalemia 1) hyperkalemia is\u00c2\u00a0plasma K+ &gt; 5.0 mmol\/L (if &gt; 7.5 mmol\/L, becomes life threatening 2) caused by increased release from cells (intravascular hemolysis, tumor lysis syndrome, rhabdomyolysis), decreased clearance by kidney due to acute or chronic kidney failure, excess intake (often iatrogenic) Signs and Symptoms 1) weakness up to flaccid paralysis 2) [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[63,11],"tags":[1153,1157,1150,1151,1158,5356,1155,1154,1156,1152],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Hyperkalemia - InsideSurgery Medical Information Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/insidesurgery.com\/2010\/02\/hyperkalemia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hyperkalemia - InsideSurgery Medical Information Blog\" \/>\n<meta property=\"og:description\" content=\"Pathophysiology of Hyperkalemia 1) hyperkalemia is\u00c2\u00a0plasma K+ &gt; 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