Episode 189: Hyperkalemia 2.0
Core EM - Emergency Medicine Podcast - Un pódcast de Core EM
We revisit the topic of Hyperkelamia to update our prior episode from 2015 (pre-Lokelma)
Hosts:
Brian Gilberti, MD
Jonathan Kobles, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Hyperkalemia.mp3
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Tags: Renal Colic
Show Notes
Introduction
* Background
Physiology:
Normal range and the significance of deviations (>5.5 mEq/L)
Epidemiology:
Prevalence of hyperkalemia in the ER
ESRD missed HD → ECG, monitor
Causes / Risk Factors
Causes
Kidney Dysfunction, Medications, Cellular Destruction, Endocrine Causes, Pseudohyperkalemia
* High-Risk Medications:
* Antibiotics: Bactrim, antifungals
* Calcineurin inhibitors
* Beta-blockers
* ACE/ARB
* K+ Sparing diuretics
* NSAIDs
* Digoxin
* SUX – high risks in neuromuscular disease
Lab errors, hemolysis in samples
VBG vs Chem accuracy
When to repeat a hemolyzed sample
2023 study: Of the 145 children with hemolyzed hyperkalemia, 142 (97.9%) had a normal repeat potassium level. Three children (2.1%) had true hyperkalemia: one had known chronic renal failure and was referred to the ED due to concern for electrolyte abnormalities; the other 2 patients had diabetic ketoacidosis (DKA).
Clinical Presentation / eval
Symptomatic vs. Asymptomatic:
“First symptom of hyperkalemia is death”
If severe, ascending muscle weakness → paralysis
Point at which patients experience symptoms depends on chronicity
>7 mEq/L if chronic and can be lower if acute
Hyperkalemia can be a cause of non-specific GI symptoms
EKG Changes:
ECG findings may be the first marker the ER doc gets that something is wrong
Typical changes:
Peaked T-waves, shortened QT
Lengthening of PR interval and QRS duration
Bradycardia / Junctional rhythm
Hyperkalemia can produce bradycardia without other ECG findings
Ones associated with VT/VF/code,
