Hyperkalemia Management

🔥 Hyperkalemia: Management

🛠️ Management of Moderate Hyperkalemia

Obtain EKG and confirm with repeat labs: 5.5 < K < 6.5 and no EKG changes.
Remove K+ from body using sodium zirconium cyclosilicate (feces) or loop diuretic (urine).

⚡ Management of Severe Hyperkalemia

Obtain EKG and confirm with repeat labs: K+ >6.5 or EKG changes.
Stabilize myocardium with calcium gluconate.
Shift K+ into cells using insulin + glucose ± albuterol. If low pH, give bicarbonate.
Remove K+ using sodium zirconium cyclosilicate or loop diuretic.
If refractory or renal failure: dialysis.

⚠️ Complications: Untreated hyperkalemia → high risk of cardiac arrhythmia!

🔎 HYF (High-Yield Fact):
Mild hyperkalemia might be lab artifact. Severe hyperkalemia = emergency! Treat quickly to prevent fatal arrhythmias (peaked T wave, PR prolongation, wide QRS, BBB).

🩸 Cell Lysis

Case: A 30-year-old man with leukemia on chemotherapy presents with palpitations, nausea. Exam: unremarkable. Labs: high uric acid, K 6.8, phospho 6.0. EKG: wide QRS, peaked T waves, PR prolongation.

🛠️ Management:
- Same as severe hyperkalemia + dialysis if needed.
- IV fluids (avoid lactated ringers due to K+).

🔎 HYF: Cell lysis = intracellular contents spill → electrolyte disaster (e.g., tumor lysis, rhabdomyolysis, crush injuries).

🧪 AKI (Acute Kidney Injury)

Case: An 89-year-old man with dementia presents with failure to thrive. On exam: dry mucous membranes, temporal wasting. Labs: K 5.3, Cr 1.5.

🛠️ Management:
- AKI workup: UA, BMP, bladder scan.
- Correct dehydration (IVFs), monitor electrolytes.

🔎 HYF: Mild hyperkalemia may be monitored. Moderate-severe needs treatment. Common AKI causes: dehydration, urinary retention, CHF, cirrhosis.

🧠 CKD (Chronic Kidney Disease)

Case: A 50-year-old man with DM2, HTN, and CKD on routine visit. Exam: normal. Labs: Cr 1.8, K 5.1.

🛠️ Management:
- Refer to nephrology.
- Manage comorbidities.
- Counsel on low-K diet.

🔎 HYF: CKD can progress to ESRD. AKI superimposed on CKD worsens hyperkalemia dramatically!

💊 Medication Use

Case: A 73-year-old man on β-blocker, ACEi, spironolactone, and naproxen. Exam: normal. Labs: Cr 1.2, K 5.3.

🛠️ Management:
- Stop offending agents.
- Start low K diet.

🔎 HYF: β-blockers, ACEi, NSAIDs, K-sparing diuretics, and digoxin can all cause hyperkalemia by interfering with renal potassium excretion.

🧪 Metabolic Derangement (DKA)

Case: A 45-year-old man with DM1 presents with DKA. On exam: tachycardia, dry membranes, abd tenderness. Labs: glucose 560, anion gap 23, K 5.3.

🛠️ Management:
- IV fluids.
- Insulin drip (insulin → intracellular K shift).
- Replete K once K normalizes during insulin therapy.

🔎 HYF: DKA = extracellular K high but total body K low. Insulin moves K back into cells, but if not supplemented, can cause severe hypokalemia during treatment.

✨ Quick Reminder

Always check EKG first in hyperkalemia. Peaked T waves mean act FAST!