Hyperkalemia

Hyperkalemia: Sx = muscular weakness

  • 1) Recheck potassium level: Rule out hemolyzed blood sample (broken cells release intracellular K+).
  • 2) EKG – stat: Look for diffuse peaked-T waves! No P waves!
    1. ***No P waves: Think Hyperkalemia or Afib ***
    2. EKG changes? Give 1-2 amps Calcium Gluconate (cardiomembrane-protective/stabilize)

Potassium EKG explainedPotassium EKG

hyperkalemia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

        

 

 

 

 

 

 

 

 

 

Kayexalate 15g PO or 50g/50ml PR – binds K+ and removes in stool.

  1. Consider avoiding Kayexalate if patient has a sacral ulcer (want less stool contaminating wound). Kayexalate takes time to remove potassium (via stool).
  • May also give: Force K+ into cells.
    • Glucose (D50: IV Dextrose 50g = Dextrose 50% soln 50ml) + IV Insulin 10U.
      • Consider starting D10 125ml/hr following Glucose and Insulin.
      • Consider adding D5 ½ NS at 75ml/hr for 300ml. AccuCheck q1hr X 3 hours to follow BG. Give additional D50 amp PRN for low BG.
        • May need to continue monitoring for up to 4-6 hours afterwards as patient’s BG can continue to decrease requiring multiple D50 injections. Follow closely.
    • Bicarb drip
    • Albuterol nebulized breathing treatment
  • Give Lasix (Furosemide): K+ – wasting diuretic (urinate potassium).
  • If really high/nothing else works: Hemodialysis to physically remove the K+ from the blood.
    • Ex: Patient presents with K+ 8.5:
      • Recheck K+ stat to confirm elevated.
      • Order stat EKG to assess for EKG changes.
      • Ordered Calcium gluconate stat.
      • Order Insulin 10U + D50 stat. Can also order Lasix stat.
        • If repeat K+ is still > 7.0, then contact Nephrology for hemodialysis to forcibly remove potassium from blood.
  • Hold Lisinopril/Losartan if K+>5.5.
  • Watch for hyperkalemia if changing meds: Adding Lisinopril and Spiranolactone.

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