Hyperkalemia

• • Elevated serum potassium

Epidemiology

• • Severe trauma

  • Burns

  • Crush injuries

  • Renal insufficiency

  • Marked catabolism

  • Addison disease

Symptoms and Signs

• • Nausea

  • Vomiting

  • Colicky abdominal pain

  • Diarrhea

Laboratory Findings

• • Elevated serum potassium

  • Peaked T waves

  • Wide QRS

  • Depressed ST segment

• • Addison disease

Rule Out

• • Hemolysis

  • Leukocytosis

  • Thrombocytosis (> 1,000,000/µL

  • Abnormalities of acid-base status (acidosis)

  • Addison disease

• • Serum electrolytes

  • CBC with platelets

• • IV 100 mL D50 with 20 U regular insulin

  • IV NaHCO3

  • IV calcium

  • Sodium polystyrene sulfonate orally or by enema (40-80 g/d)

  • Hemodialysis

  • β-Agonists (inhaled)

Medications

• • D50/insulin

  • Calcium

  • Sodium polystyrene sulfonate

  • NaHCO3

  • Albuterol

Treatment Monitoring

• • Serum electrolytes

  • ECG

Complications

• • Diastolic cardiac arrest

Prognosis

• • Excellent

References