Hyperkalemia
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Causes
Pseudohyperkelamia and RBCS hemolysis in simple Oliguria, renal failure, potassium sparing diuretics, NSAIDS like indomethacin and piroxicame hemolysis, rhabdomyolysis, hyperglycemia
Clinical Features
Flaccid paralysis in the leg then arms muscle weakness paraesthesia of face, tongue, feet etc nausea, diarrhea diagnosis serum potassium - 6 mEq / L. ECG change : T - peaked t waves pericardial leads- wide QRS complex prolonged PR interval - decreased amplitude or disappearance of P waves.
Investigations
Serum electrolytes, ECG
Diagnosis
Serum potassium > 6 meq / L & ECG changes (peaked T waves in pericardial leads, wide QRS Complex, prolonged PR interval, decreased amplitude or disappearance of P waves).
Management
- Dietary restriction of k, diuretics, NSIADS, ACE inhibitors, Beta blockers
- Ion exchange resin i.e., kayaxalate (sodium polystyrene) 15mg PO TDS with Syrup Duphalac / Lilac (lactulose)
- In case of severe hyperkalemia i.e., K > 6.5
- Inj- Calcium gluconate 10 %, 10cc IV slowly over 10 min
- Inf- 5 hypertonics (25% dextrose) + Inj - insulin plain 10-20 units IV over 20-30 minutes
- Inj- Soda bicarb 1-2 Ampules iv stat diluted (avoid it if there is fluid overload)
- Ventolin neb stat / SOS
- Dilute Potassium oxalate ( lon exchange resin powder in 30ml Lactulose (Duphalac) syp and give 2TSF PO TDS (not more than 3 days)
- If still hypokalemia is not corrected, go for haemodialysis.