Hyperkalemia
• 62 y/o male, diabetic, with chronic kidney
disease
• Creatinine of 3.5 mg/dL
• Estimated GFR of 15ml/min
• CC: inability to lift himself from a chair
• Eating fruits with each meal for the past 2
weeks
Hyperkalemia
• PE: Marked proximal weakness and decreased
skin turgor
• ECG: peaked T waves and widening of the P
wave and QRS complex
Hyperkalemia
Blood Test
Plasma Na
130 meq/L
K
8.5 meq/L
Chloride
98 meq/L
HCO3
17 meq/L
Creatinine
2.7 meq/L
pH
Capillary blood glucose
Serum acetone
7.32
400 mmol/L
(+)
Factors responsible for the elevation of
plasma potassium
• Chronic renal failure – decreased excretion of
potassium
• Ingestion of foods high in potassium such as
bananas and oranges – excessive exogenous
potassium load
• Some medications such as NSAIDs
Pseudohyperkalemia?
• This is not pseudohyperkalemia
• Pseudohyperkalemia is a result of:
– Hemolysis (in laboratory tube) most common
– Thrombocytosis
– Leukocytosis
– Venipuncture technique (ie, ischemic blood draw
from prolonged tourniquet application)
Clinical manifestations of hyperkalemia
• Cardiac and neurologic symptoms
predominate
• Patients may be asymptomatic or report the
following:
– Generalized fatigue
– Weakness
– Paresthesias
– Paralysis
– Palpitations
Clinical manifestations of hyperkalemia
• Pathophysiology
– Major intracellular ion
– Concentration gradient maintained by the Na/KATPase pump
– Important in maintaining cellular membrane
potential. That is why tissues that are excitable
(e.g. muscles and nerves) are affected.
Management
• Requires prompt treatment since
hyperkalemia is severe (>7 meq/L)
• ECG monitoring
• Medications
– Calcium chloride - restores normal gradient
between threshold potential and resting
membrane potential, since it is elevated in
hyperkalemia
Management
• Medications
– Insulin - stimulates cellular uptake of K+ within 2030 mins. It must be administered with glucose to
prevent hypoglycemia
– Sodium bicarbonate - increase the pH, promotes
temporary potassium shift from the extracellular
to the intracellular environment
– Furosemide – promotes renal excretion of
potassium
Management
• The patient should undergo hemodialysis if
deemed necessary