Health Awareness blog

 

Hyperkalemia is an emergency and needs urgent treatment. Hyperkalaemia is diagnose when a plasma potassium >6.5mmol/L.

Signs and symptoms:

·         ECG = Tall tented T waves, small p wave, wide QRS complex becoming sinusoidal, VF

·         Cardiac arrhythmias

·         Sudden death

Causes:

Spurious:

·         Leakage of potassium from erythrocytes when separation of serum from clot is delayed (artifact, the plasma potassium is normal)

·         Release of potassium from marked thrombocythaemia (platelets count high) or leucocytosis (high white cell count)

·         Repeated fist clenching during blood taking (release of potassium from muscle)

·         Specimen taken from arm with potassium infusion

Decreased excretion:

·         Acute or chronic renal failure

·         Renal secretory defects – this may be found in renal transplant, interstitial nephritis, systemic lupus erythematosus (SLE), sickle cell disease, amyloidosis, obstructive uropathy,

·         Addison’s disease (due to loss of function of hormone aldosterone which is responsible for potassium excretion in kidney)

·         Hyporeninemic  hypoaldosteronism – A rare condition where low levels of rennin result in insufficient aldosterone being produce (often seen in diabetic patients with mild to moderate nephropathy) or selective hypoaldosteronism (some patients with AIDS)

·         Heparin (this will suppress aldosterone secretion)

·         Drugs that inhibit potassium excretion (e.g.: spirinolactone, eplerenone, triamterene, ACE inhibitors, angiotensin II receptor blockers, trimethoprim, NSAIDs, cyclosporine, tacrolimus)

Shift of potassium from within the cell

·         Massive release of intracellular potassium – seen in burns, rhabdomyolisis, hemolysis, severe infection, internal bleeding, vigorous exercise

·         Metabolic acidosis (e.g.: diabetes mellitus)

·         Hypertonicity (solvent drug)

·         Insulin deficiency 

·         Hyperkalemic periodic paralysis

·         Drugs: succinylcholine, arginine, digitalis toxicity, beta adrenergic antagonists

·         Alpha adrenergic stimulation

·         Massive blood transfusion

Excessive intake of potassium:

·         Excessive intake of food rich of potassium (e.g.: banana)

·         Excess potassium therapy

Hyperkalemia can be prevented by controlling the disease and frequent monitoring of electrolytes if the patients take the few medications that have been listed above.

 

Treatment:

Treat underlying cause is the means of treatment. In emergency cases, the management should be:

·         10ml intravenous calcium gluconate (10%) over 2 min, repeated as necessary if ECG changes is severe. This is only to provide cardio-protection. Serum potassium will remain high without other treatment. Caution should be taken with calcium guconate because it may cause skin necrosis if extravasation. This drug should not be injected into small peripheral cannulae.

·         Intravenous insulin (e.g.: 10unit insulin) will moves the potassium into the cells. It usually given with intravenous glucose (e.g.:50ml of 50% glucose solution)

·         Nebulized salbutamol (2.5mg) will also have the same effect with insulin

·          Polystyrene sulfonate resin either orally or enema if patient has problem to take orally. This should colonic irrigation after about 9 hours to remove the potassium from the colon.

·         Dialysis will be done if none of these things works

 

Reference:

1.       Oxford handbook of Clinical Medicine. 7^th edition. Oxford University Press. 2008.

2.       http://en.wikipedia.org/wiki/Addison_disease

3.       Current Medical Diagnosis and Treatment. Mc Graw Hill. 2008.

4.       http://www.wrongdiagnosis.com/h/hyporeninemic_hypoaldosteronism/

 

 

Tags: addison's disease, aldosterone, calcium gluconate, cardiac arrythmia, hemolysia, hyperkalemia, metabolic, metabolic acidosis, salbutamol, sudden death

Technorati Tags: addison's disease, aldosterone, calcium gluconate, cardiac arrythmia, hemolysia, hyperkalemia, metabolic, metabolic acidosis, salbutamol, sudden death

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