Day 2 - Hyperkalemia

*Cardiac changes most commonly occur with K+>6, but can occur at any level. Always get an ECG to monitor for Hyperkalemia induced changes.
Mild: K+ 5 - 5.5
Moderate: K+ 5.5 - 6.5
Severe: K+ >6.5

Hyperkalemia Etiologies:

• Drugs - ACE inhibitors, NSAIDs, ARBs, Septra, Potassium Supplements, Spironolactone

• Renal failure

• Metabolic abnormalities: Metabolic acidosis, Rhabdomyolysis, TLS, Hemolysis

• Endocrine: Insulin insufficiency (ie: DKA) - reported hyperkalemia but whole body stores is potassium DEPLETE, Adrenal Crisis

Drug Dosing:

• Cardiac instability - Any EKG changes (regardless of K value) should be treated immediately with 1 amp Calcium Gluconate

• Shifting:

  • 1/2 - 1 amp D50W (depending on patient’s glucose level), followed immediately by 10 units Insulin R IV

    • Temporary measure

  • Repeat K+ in 3-4 hours

• Excretion

  • Kay-exelate 15-30g daily - QID

    • increased risk of bowel necrosis

  • PEG 17g PO Daily - BID or Lactulose 30mL PO q6h

    • Has been demonstrated to be similarly effective to Kay-exelate

  • Furosemide in patients who are volume overload only

  • Dialysis

    • If refractory to medical management