Management of hyperkalemia - hopetomatchsoon

[ArchivalUser]

Can anyone tell me what drugs, other than calcium gluconate, are used to stabilize and protect the heart from hyperkalemia? I always get confused with this.

[ArchivalUser]

Ok, a little review of Hyperkalemia.... From Master Fischer (Step 3 and CK MTB)


Hyperkalemia

Hyperkalemia is predominantly caused by increased potassium release from tissues, such as muscles, or RBC, such as in rhabdomyolysis or hemolysis. Increased dietary potassium can only cause hyperkalemia if it is associated with renal insufficiency. If kidney function is normal, it is almost impossible to ingest potassium faster than the kidney can excrete it. Also, the GI tract is not able to absorb potassium faster than the kidney can excrete it. Aldosterone normally functions to excrete potassium from the body. If there is a deficiency or blockade of aldosterone, potassium levels will rise. Other causes of hyperkalemia are the following: Metabolic acidosis from transcellular shift out of the cells Adrenal aldosterone deficiency, such as from Addison’s disease Beta blockers Digoxin toxicity Insulin deficiency, such as from diabetic ketoacidosis (DKA) Diuretics, such as spironolactone ACE inhibitors and angiotensin receptor blockers, which inhibit aldosterone.
Prolonged immobility, seizures, rhabdomyolysis, or crush injury Type IV renal tubular acidosis, resulting from decreased aldosterone effect Renal failure, preventing potassium excretion Pseudohyperkalemia is an artifact caused by the hemolysis of red cells in the laboratory or prolonged tourniquet placement during phlebotomy. Pseudohyperkalemia does not need therapy; you need only repeat the test. Hyperkalemia can lead to cardiac arrhythmia. Potassium disorders are not associated with seizures or neurological disorders.

Remember: First peaked T-waves occur, then loss of the P-wave, and then the widened QRS complex occurs.

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Treatment

Severe Hyperkalemia
(EKG abnormalities, such as peaked T-waves)
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1) Administer CALCIUM GLUCONATE intravenously to protect the heart.
2) Follow with INSULINE and glucose intravenously.
3) BICARBONATE to shift potassium into the cell when acidosis is the cause of the hyperkalemia

Moderate Hyperkalemia
(no EKG abnormalities)
-----------------------
1) Administer INSULIN and glucose intravenously. Lowers the K through redistribution into the cells

2) Use BICARBONATE to shift potassium into the cell when acidosis is the cause of the hyperkalemia or there is rhabdomyolysis, hemolysis, or another reason to alkalinize the urine.

3) KAYEXALATE (potassium-binding resin) is administered orally to remove potassium from the body. This takes several hours.

Other methods to lower K:
Inhaled BETA AGONISTS (Albuterol)
LOOP DIURETICS
DIALYSIS

TIP: Hyperkalemia + abnormal EKG >>> CALCIUM GLUCONATE !!!

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 6191-6200).