“Knowing the enemy is half a battle “ yes in the previous topic we discussed why the hyperkalemia is a emergency and now we are going to know what are the most common causes of hyperkalemia and how to manage it.
CAUSES :
Increased POTASSIUM INTAKE from food (pottasium rich diet )- mostly in patients with compromised renal function
Patients on TPN ,MASSIVE BLOOD TRANSFUSIONS and RHABDOMYOLYSIS also will develop - HYPERKALEMIA
INTRACELLULAR POTASSSIUM SHIFT - 98% k+ were intracellular (140mEq/L) and 2%(3.5 to 5 mEq /L) only extracellular - Thus,SEPSIS ,METABOLIC ACIDOSIS also will lead to HYPERKALEMIA
Due to impaired excretion - k+ is actively secreted in distal tubules and collecting ducts under the influence of aldosterone and impaired kidney function lead to HYPERKALEMIA (most commonly seen in CKD patients)
MANAGEMENT:
The treatment for hyperkalemia starts with
*Avoiding the exogenous sources of potassium (potassium rich diet ),or kcl syrup
*Since k+ plays a major role in cardiac action potential ( in phase 3 )for cardiac stabilization iv calcium gluconate given as a first line treatment (Although calcium chloride contains 3 times more elemental calcium than calcium gluconate ,it may extravasate and cause tissue necrosis ,so calcium gluconate is mostly preferred)
Insulin 10 units in 25D or insulin alone in case of hyperglycemic patients given since insulin will drive potassium back into cells.
Beta 2 agonists such as albuterol ( SALBUTAMOL)as nebulizer will also shift potassium intracellularly and
HEMODIALYSIS - in case of refractory hyperkalemia
Yup, although managing the hyperkalemia as such we discussed above it should be treated fully by knowing the underlying cause and managing accordingly.”knowing the enemy is half a battle ;the other half is act before it wins “,so will act swiftly and win the battle.
MBH/AB