Hyperkalemia

STUDY
PLAY
What are the 4 biggest risk factors for hyperkalemia in heart failure patients?
Diabetes
Poor creatinine clearance
Spironolactome
ACE inhibitors
The causes of hyperkalemia can be classified into which 4 groups?
Decreased excretion
Increased intake
Potassium redistribution - extracellular shift
Drugs
What is the most common cause of hyperkalemia?
Renal failure
Which type of renal tubular acidosis causes hyperkalemia?
Type IV
How do you classify the causes of potassium extracellular shift resulting in hyperkalemia?
Hyperosmolar states e.g. hyperglycaemia, volume depletion leading to hypertonicity

Acidosis

Tissue breakdown e.g. tumour lysis syndrome, rhabdomyolysis, haemolysis

Toxins/drugs e.g. propofol infusion syndrome, suxamethonium, digitalis intoxication syndrome
What are 4 common exogenous sources of potassium?
Potassium supplements
Total parenteral nutrition
Packed red blood cell transfusion
Dietary sources
What are the symptoms of hyperkalemia?
(often none)
Weakness
Palpitations
Constipation
What are the signs of hyperkalemia?
(often none)
Decreased power
Decreased bowel sounds
What are the ECG changes that accompany hyperkalemia - divided into early, intermediate and late changes?
Early changes: tented T waves (most common), shortened QT interval

Intermediate changes: widened QRS complex, flattening and loss of p wave, increased PR interval progressing to complete heart block

Late changes: sinusoidal pattern, ventricular fibrillation
Do most patients with hyperkalemia have an abnormal ECG?
No - from a 1998 cohort study of 242 patients, 46% had ECG changes
How do you manage hyperkalemia?
Protect the heart: IV calcium glucanate

Shift potassium into cells: insulin + dextrose, sodium bicarbonate, beta agonists e.g. salbutamol

Get potassium out of the body: resonium, frusemide, dialysis
YOU MIGHT ALSO LIKE...