Hyperkalemia

 

Manifestations

Neuromuscular Cardiac/EKG:
  • paresthesias
  • muscle cramps
  • decreased DTRs
  • decreased  vibratory/position sense
  • weakness lethargy

  • 6-7 mEq/l - decreased QT interval; increased T amplitude

  • >8 mEq/l - increased PR interval, decreased P amplitude

  • >9 mEq/l - loss of P, increased QRS, V-fib, sine-wave, asystole

 

 

Treatment

<6.0 mEq/l no symptoms or EKG changes:

>6.0, symptomatic, or EKG changes:
initiate some or all of the following depending on clinical setting

1. Restrict K

2. Liberalize Na
  1. Ca-gluconate: 5-10 cc of 10% solution IV over 2 min. (may repeat x 1 in 5 min.)
  2. NaHCO3  one amp IV over 2-5 min. (may repeat x 1 in 15 min.)
  3. Glucose and insulin:  one amp D50W and 5-10 U reg. insulin IV over 2 minutes or 500 cc D5W and 10-20 U reg. insulin IV over 30 minutes
  4. Cation - exchange resin:  Kayexalate 50g in 200 cc 33% Sorbitol solution (premixed) q 4 hrs. PO or Kayexalate 50g in 200 cc H2O PR
  5. Dialysis
  6. Note:  Only steps 4 and 5 remove potassium from the body.

 

 

Disposition

If K < 6.0 mEq/l, patient is asymptomatic without EKG changes, and repeat K in ED is not increased, patient may be treated as an outpatient with close follow-up.  All other patients should be admitted to a monitored bed.