Nephrology Book

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Hyperkalemia

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  1. Causes
    1. See Hyperkalemia Causes
  2. Signs and Symptoms
    1. Symptoms occur when Serum Potassium > 6.0 to 6.5 meq/L
    2. Neurologic Changes
      1. Weakness
      2. Paresthesias
      3. Areflexia
      4. Ascending paralysis
      5. Respiratory failure
    3. Cardiovascular Changes
      1. Bradycardia to Asystole or Ventricular Fibrillation
      2. AV prolonged transmission to complete Heart Block
  3. Labs
    1. Chemistry Panel
      1. Serum Potassium
      2. Serum electrolytes including serum bicarbonate
      3. Renal Function tests (BUN, Creatinine)
    2. Spot urine for Urine Potassium and Urine Creatinine
      1. Fractional Excretion of Potassium
      2. Transtubular Potassium Gradient
  4. Diagnostics: Electrocardiogram
    1. Changes occur when Serum Potassium >6.0 meq/L
    2. Initial
      1. T Waves peaked or Tented
    3. Next
      1. ST depression
      2. First degree AV Block or loss of P Wave
      3. QRS widening
    4. Final
      1. Biphasic wave (sine wave) QRS and T fusion
      2. Imminent ventricular standstill
    5. Changes exacerbated by:
      1. Hyponatremia
      2. Hypocalcemia
      3. Metabolic Acidosis
      4. Hypermagnesemia
  5. Management
    1. See Hyperkalemia Management
  6. References
    1. Gibbs in Marx (2002) Rosen's Emerg Med, p. 1730-1
    2. Klahr (2001) in Noble (2001) Primary Care p. 1359-62

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