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Hyperkalemia

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  • • 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

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Greenberg A. Hyperkalemia: treatment options. Semin Nephrol. 1998;18:46.  [PubMed: 9459288]
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Mahoney BA. et al. Emergency interventions for hyperkalaemia. Cochrane Database of Systematic Reviews. 2005, (2):CD003235.

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