Hyperkalemia

Definition:

• Serum K+ >5.3-5.5

 

Etiology:

• Pseudohyperkalemia- K release from cells after blood draw, IVF with K
• Hemolysis
• Marked thrombocytosis or leukocytosis
• Excessive K intake
• Ingestion (K Supplements, dietary salt substitutes)
• Iatrogenic
• Impaired excretion
• Low GFR (AKI or CKD)
• Low mineralocorticoid state (adrenal insufficiency, type IV RTA)
• Drugs (spironolactone, ACEi, ARB, TMP-SMX, NSAIDs, digitalis overdose, heparin, chemo therapeutic agents)
• Shift from intracellular to extracellular compartment
• Acidosis
• Insulin deficiency or resistance including DKA
• Cell death (rhabdomyolysis, burns, tumor lysis)
• Retroperitoneal hemorrhage
• Old (hymolyzed) pRBC transfusion

 

Clinical manifestations:

• Weakness, nausea, paresthesias, palpitations

Evaluation:

• Repeat serum K+ and assess renal function studies including serum Cr and BUN
• Order stat ECG to evaluate for hyperkalemia related changes (Tall peaked “tented” T waves, PR interval prolongation followed by loss of P waves, QRS widening, sinus wave pattern, VF/asysteole/PEA
• Review medications for offending drugs and stop as appropriate/indicated

 

Management: