Hyperkalemia

K⁺ > 5.5

*Place patient on continuous ECG monitoring

Signs and symptoms:
- generalized weakness, irritability,paresthesias, decreased DTRs, paralysis, cardiac arrhythmias

ECG manifestations:
Mild – peaking of T waves, PVCs
Severe – peaked T waves, widening of the QRS complex, decreased ST segments, prolongation of PR interval, PVCs, ventricular tachycardia, fribrillation, cardiac arrest

Management:
1) Repeat potassium level if suspect lab error, hemolyzed specimen
2) Stop all potassium intake (PO and in IVF)
3) continuous ECG monitoring

If ECG changes present or if symptomatic
4) administer calcium to protect heart
 - CaCl 10-20 mg/kg (max 500 mg) or CaGluconate 50-100mg/kg
 - Note – stop infusions for HR<60 (Don’t forget to flush afterwards)

5) Bicarbonate to correct acidosis and drive K+ into cells
 - Na HCO₃ 1-2 mEq/kg ver 5-10 min
 - Note – can repeat if ECG changes persist while insulin/glucose being prepared

6) Insulin to also drive K⁺ into cells, administer w /glucose to prevent
hypoglycemia
 - 1st give D₂₅ 2 ml/kg or D₁₀ 4ml/kg
 - then insulin 0.1units/kg over 10-30min

7) Kayexelate 1gm/kg PO or PR to bind K⁺

Dialysis

- other labs to check: chem. 7, calcium, magnesium, phosphorus
- identify underlying cause if hyperkalemia and treat if possible
- dialysis if renal failure
- exogenous mineralocortcoids if mineralocorticoid deficiency
- stop any K sparing diuretics or other meds that raise K levels
- correct coexisting Mg deficiency