Hyperkalemia - Tagged.pdf

Hyperkalemia/ Electrolytes C. Mateo Garcia, MD Flow rate factors The rate a fluid can flow through a tube is defined by laws of physics with the following formula: (Change in Pressure) x Radius4 Length of the Catheter Hyperkalemia Risk factors: ● ● ● ● ● ● Dialysis Acute renal disease Severe cr...

Hyperkalemia/ Electrolytes C. Mateo Garcia, MD Flow rate factors The rate a fluid can flow through a tube is defined by laws of physics with the following formula: (Change in Pressure) x Radius4 Length of the Catheter Hyperkalemia Risk factors: ● ● ● ● ● ● Dialysis Acute renal disease Severe crush injuries Rhabdomyolysis Severe infections Burns Hyperkalemia and EKG progressions Hyperkalemia ● ● ● ● Toxic effects on heart Destabilizes cardiac myocytes Can lead to cardiac dysrhythmia and cardiac arrest if untreated. Treatment is designed to stabilize cardiac myocytes, shift potassium temporarily to inside of cells to hide it, and then give meds to get it out of the body. Hyperkalemia treatment: 5 steps 1. Calcium Gluconate (Calcium Chloride in Cardiac Arrest). 2. Insulin & Glucose 3. Sodium Bicarbonate 4. Albuterol 5. Furosemide/ Kayexalate?? /Dialysis ● ● ● Hyperkalemia treatment : Calcium gluconate Counteracts toxicity of hyperkalemia by stabilizing cardiac myocyte cell membranes. Stabilizes cardiac myocytes by increasing threshold potential. Reduces risk for V fib. Contraindications: Causes significant tissue necrosis if given any route other than IV Sodium Bicarbonate ● ● ● ● Classified as an electrolyte Serves as buffer and can counteract acidosis. Can help with TCA overdoses, also drug intoxications (e.g. Barbiturates, salicylates and methyl alcohol). Historically given in cardiac arrest although this is changing somewhat. Do not administer into IV or IO with other medications Insulin, Regular ● ● ● ● Class: Hormone Binds to insulin receptor on cell membranes and facilitates glucose transport into cell. Also brings K + into cells by activation of second messenger onto Na/K+ ATPase. Only regular insulin can be given IV. Contraindications: Hypoglycemia, relative contraindication of liver/renal disease (typically just lower dose). Furosemide (Lasix) ● ● ● ● Class: Loop Diuretic Allows for significant loss of potassium in the urine. If on dialysis make sure they still produce urine. Onset IV is ~15 minutes, lasts six hours. Hyperkalemia treatment: 5 steps 1. 2. 3. 4. 5. Calcium Gluconate (Calcium Chloride in Cardiac Arrest). Stabilize Cardiac Myocytes Insulin & Glucose Hides glucose intracellularly Sodium Bicarbonate Rapidly hides potassium inside cell Albuterol Rapidly hides potassium inside cell Furosemide/ Kayexalate?? /Dialysis Actually removes Potassium from body.