Hyperkalemia

DEFNITION:
> 5 MEQ/L.
Causes

1. Cush injuries, burn, and other catabolism inducing events.

2. Renal insufficiency
3. Adrenal insufficiency (Hypoaldosteronism)
4. Excessive potassium administration
5. Acidosis
6. Drugs(Angiotensin-converting enzyme (ACE) inhibitors, potassium
sparing diuretics).
7.Iatrogenic causes: Penicillin G contains 1.7 mEq K per 1 million units, KCl added to
maintenance fluids, blood transfusion with old batch of packed red blood cells
(PRBCs) where K may have leaked out of cells, overtreatment of hypokalemia.

8. Digoxin toxicity can cause severe hyperkalemia by blocking the sodium potassium
adenosine triphosphatase (ATPase) pump.

8. Pseudohyperkalemia: Can result when RBCs lyse in the test tube and release
potassium. This is a lab error: Repeat test before treating!
 sign and symptom of hyperkalemia

Skeletal
muscle
cardiac GIT

Nausea
weakness arrythmias

Vomiting
Start lower Cardiac
paralysis
extremities and
move upward arrest diarrhea
Investigation for Hyperkalemia:

1- Serum Potassium
5.5 - 6.5 mEq/L is MILD
6.5 - 8 mEq/L is MODERATE
> 8 is SEVERE

2- ECG: is important to assess the physiologic effect of high

potassium on the heart
3- Glucose level

4- Renal Function Test: BUN and Creatinine

5- spot urine test (potassium, creatinine, and osmoles)

6- transtubular potassium gradient

Treatment of Hyperkalemia:

● Place patient on a cardiac monitor

● Discontinue any potassium-sparing drugs or dietary
potassium
● CALCIUM GLUCONATE - CHLORIDE
● INSULIN WITH GLUCOSE
● Beta adrenergic agonist
Hypokalemia
less than 3.5 mEq/L.
 Bashaier albalawi

Hypokalemia
presentation
• Mild hypokalemia
(K+ >3 mmol/L [11.7 mg/dL]) is generally asymptomatic.
• Symptoms occur with severe K+ deficiency
(K+ <3 mmol/L [11.7 mg/dL])
The hallmark signs of hypokalemia are decreased
muscle contractility
• Weakness , Paralysis , paraesthesia,decrease reflexes
• Ileus , constipation, nausea, vomiting , abdominal distention
• diaphragmatic paralysis
Investigations:
ARTERIAL BLOOD GASES
SERUM POTASSIUM:
<3.5 MEQ/L
URINE POTASSIUM
SERUM MAGNESIUM: ASSAY IS ALSO IMPORTANT IN THE D&D.
ECG: TO DETERMINE WHETHER THE HYPOKALEMIA IS AFFECTING
CARDIAC FUNCTION OR TO DETECT DIGOXIN TOXICITY .
[DECEASED AMPLITUDE OF THE P WAVE ,OR APPEARANCE OF A U
WAVE .
Treatment of hypokalemia :
❖ Check Mg level first as hypomagnesaemia is commonly associated with
hypokalemia and must be corrected before/along with hypokalemia.
❖ Oral replacement ; indicated when K level is above 3mEq.(In
asymptomatic patient)
❖ IV replacement ; indicated when patient cannot tolerate oral intake
OR K Below 3 mEq.
❖ Amount of K to be replaced can be conservatively estimated as: (4.0 –
current K) × 100, in mEq.
Example: if current K is 3.1, give 90 mEq (total, not all at once!!!),
❖ No more than 40 mEq should be added to a liter of IV
fluid since rapid K administration can cause fatal
arrhythmias.

❖Rate should not exceed 40 mEq/hr.

❖ May cause a burning sensation if given in peripheral

IV. Using low flow rate of 10 mEq/hr or adding a small
amount of lidocaine to the solution can decrease
discomfort
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