Hyperkalemia I was perusing my ACLS handbook yesterday and realized that my ever operating optics spied another mnemonic in the treatments for hyperkalemia in an emergent situation. Before that we should briefly remember that the symptomatology of hyperkalemia is either cardiac, which is the most important and most frequent manifestation, or neuromuscular.

The cardiac Sx:

• Peaked T waves
• Flattened P waves
• Prolonged P-Q intervals
• Widened QRS complexes
• U waves
  
• VF
• Arrest

The neuromuscular Sx:

• Numbness
• Weakness
• Flaccid paralysis

Now, what should be done if we see these things and have hyperkalemia verified by serology? Beyond assessing prior labs, pertinent history and the previous two days I & Os, we will want to recall KALEMIA, and be prepared to administer the following:

• K-Kayexalate: 15-50g PO/PR plus sorbitol
  
• A-Amp of NaHCO3: repeat bolus in 15 minutes; then IV over next 1-2 hrs.
  
• L-Lasix: 40-80 mg bolus
  
• E-Emergency Hemodialysis/Peritoneal dialysis
  
• M-Memebrane effects (of K+) antagonised by CaCl: 5-10ml IV 10% solution (500-1000mg)
  
• I-Insulin & glucose (2unit:5g ratio) 1st bolus; then consider IV infusions
  
• A-Albuterol nebs: 10-20 mg over 15 minutes; may repeat

* Redistribution effect: facilitate intracellular shifting
** Removal: eliminate from body
*** Antagonism of toxic effects of hyperkalemia at cell membrane

Your colleague,
Christopher
  ¶ 7:10 PM 0 comments