Episode 189: Hyperkalemia 2.0
We revisit the topic of Hyperkelamia to update our prior episode from 2015 (pre-Lokelma) Hosts: Brian Gilberti, MD Jonathan Kobles, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Hyperkalemia.mp3 Download 2 Comments Tags: Renal Colic Show Notes Introduction * Background Physiology: Normal range and the significance of deviations (>5.5 mEq/L) Epidemiology: Prevalence of hyperkalemia in the ER ESRD missed HD → ECG, monitor Causes / Risk Factors Causes Kidney Dysfunction, Medications, Cellular Destruction, Endocrine Causes, Pseudohyperkalemia High-Risk Medications: Antibiotics: Bactrim, antifungals Calcineurin inhibitors Beta-blockers ACE/ARB K+ Sparing diuretics NSAIDs Digoxin SUX – high risks in neuromuscular disease Lab errors, hemolysis in samples VBG vs Chem accuracy When to repeat a hemolyzed sample 2023 study: Of the 145 children with hemolyzed hyperkalemia, 142 (97.9%) had a normal repeat potassium level. Three children (2.1%) had true hyperkalemia: one had known chronic renal failure and was referred to the ED due to concern for electrolyte abnormalities; the other 2 patients had diabetic ketoacidosis (DKA). Clinical Presentation / eval Symptomatic vs. Asymptomatic: “First symptom of hyperkalemia is death” If severe, ascending muscle weakness → paralysis Point at which patients experience symptoms depends on chronicity >7 mEq/L if chronic and can be lower if acute Hyperkalemia can be a cause of non-specific GI symptoms EKG Changes: ECG findings may be the first marker the ER doc gets that something is wrong Typical changes: Peaked T-waves, shortened QT Lengthening of PR interval and QRS duration Bradycardia / Junctional rhythm Hyperkalemia can produce bradycardia without other ECG findings Ones associated with VT/VF/code, death in one study: QRS widening (RR = 4.74),