Hyperkalemia

Hyperkalemia = EKG… EKG changes = Calcium…



Step 1: Recheck the Potassium



* Most common cause of hyperkalemia is PSEUDOhyperkalemia* Caused by too aggressive/fast of a blood draw* Causes RBCs to break open and falsely increase serum potassium



Step 2: Get an EKG



* Earliest EKG change* Peaked T waves* Late EKG changes* Flattened P wave* Prolonged QRS* Critical/Emergent EKG changes* Sine wave



Step 3: Protect the Heart



* EKG Changes = Give Calcium* Calcium gluconate (can be given IV)* Stabilizes the myocardium against dysrhythmia



Step 4: Shift Potassium Into Cells



* Insulin (plus D50)* Albuterol



Step 5: Remove Potassium from Body



* Kayexalate* Notorious for causing intestinal necrosis* Falling out of favor* Furosemide



Additional Reading



* Round 8 – Fall (EM Clerkship)* Emergency Management of Hyperkalemia (EM Cases)