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Hyperkalemia

  • Ddx

    • pseudohyperkalemia
      • thrombocytosis
      • leukocytosis
      • in vitro hemolysis
    • cell lysis
      • tumor lysis
      • GI bleeding
      • severe burns
      • rhabdomyolysis
      • hemolysis
    • extracellular shift
      • insulin deficiency
      • beta 2 blockade
      • acidosis
      • digoxin
      • succinylcholine
      • heparin
    • renal retention
      • K sparing diuretics
        • spirinolactone
      • hypoaldosteronism
        • ACEi
        • adrenal insufficiency
        • glucocorticoid deficiency
        • type 4 RTA
      • renal failure
        • ATN
        • sickle cell
        • renal transplant
        • CKD with GFR < 15
    • increased intake
      • iatrogenic KCl administration
      • high K diet in renal failure
  • Treatment

    • stablize cardiac membrane
      • Calcium chloride 5mL of 10% soln (for K > 7 or EKG changes)
    • shift K into cells
      • insulin 10 U with 1 amp of D5W
      • Na bicarb if acidosis
    • K excretion
      • Kayexalate 15-25g PO with 50mL of 20% sorbitol
        • If can't swallow, use PR 20g in 200mL of 20% sorbitol over 30min
        • can exacerbate CHF
      • diuretic: furosemide 20-40 mg IV
      • dialysis if severe
    • other
      • Albuterol Neb
      • digibind if digoxin toxicity
    • dialysis if severe
  • Admission orders

    • Admit: Telemetry Floor
    • Diagnosis: Hyperkalemia
    • Condition: Guarded
    • Vital Signs: Routine
    • Allergies:
    • Nursing:
      • EKG on admit and with changes in K level
      • Strict I/Os
    • Diet: Renal diet (low K)
    • Activity: As Tolerated
    • Labs:
      • CBC, Chem
      • Repeat K in 4 hours
      • UA, urine K
      • EKG (T waves, long PR, short QT, sine waves if severe)
    • IV: NS 200 mL/h for 6 Hours (contraindicated in dialysis or anuric pts)
    • Special: renal consult RE dialysis
    • Medications: See treatment section
  • Discharge

    • scheduled dialysis for ESRD patients
    • nutrition consult RE low K diet
  • Hyperkalemia criteria

    • K > 5.5
  • Sx

    • cardio (vfib), neuro (paralysis) and GI (vomiting, diarrhea).

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.