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Hyperkalemia

Hyperkalemias

Hyperkalemia (hyperpotassemia) is the presence of an abnormally high concentration of potassium in the blood.


Presentation

  • This review summarizes the clinical data linking hyperkalemia with poor outcomes and discusses how the efficacy of certain treatments might depend on the clinical presentation.[ncbi.nlm.nih.gov]
  • The majority of patients who present for kidney transplantation have end stage renal disease and are on dialysis. Those patients are known to be at risk for the development of hyperkalemia.[ncbi.nlm.nih.gov]
  • Chart review of presentation, physical examination, laboratory tests, and treatment. Initial potassium level was 10 mEq/L; ventricular tachycardia was observed and treated.[ncbi.nlm.nih.gov]
  • We report a clinical case; present a systematic review of available literature on secondary hyperkalemic paralysis (SHP); and also discuss pathogenesis, clinical effects, and therapeutic options.[ncbi.nlm.nih.gov]
  • We present a small case series to illustrate the breadth of the problem, along with a discussion about how such CKD/hyperkalemic events may be predicted.[ncbi.nlm.nih.gov]
Fatigue
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: November 26, 2018[patientslikeme.com]
  • When to call your healthcare provider Call your provider right away if you have any of the following: Chest pain ( call 911 ) Fainting ( call 911 ) Shortness of breath ( call 911 if severe ) Slow, irregular heartbeat Fatigue Dizziness Lightheadedness[saintlukeshealthsystem.org]
  • Amal Mattu’s ECG Case of the Week – October 23, 2017 HPI: A 55-year-old man with PMHx of end stage renal disease on dialysis presents to the ED for fatigue and pain all over. He denies ischemic chest pain. The [...][ecgweekly.com]
  • However, some individuals with hyperkalemia have reported nausea, fatigue, weakness, tingling, slow heart beat or faint pulse. How is Hyperkalemia Treated? There are several different approaches to treat hyperkalemia.[healthcentral.com]
  • However, hyperkalemia may cause the following symptoms: Nausea Vomiting Weakness Muscle fatigue Tingling or numbness Difficulty breathing Irregular heartbeat (arrhythmia) Paralysis Hyperkalemia Treatment For people with hyperkalemia caused by kidney failure[everydayhealth.com]
Hypotension
  • An 85 year-old woman on a drug regimen of sotalol, valsartan, spironolactone, and trimethoprim-sulfamethoxazole presented to the emergency department with hypotension and bradycardia.[ncbi.nlm.nih.gov]
  • Amal Mattu’s ECG Case of the Week – August 27, 2018 HPI: A 40-year-old man is brought to the ED moribund with agonal respirations, hypotension (SBP 50) and bradycardia. The following ECG was obtained and ACLS started with no response to [...][ecgweekly.com]
  • […] toxicity Clinical Features of Hyperkalemia History and examination findings Neurological effects Paraesthesia Weakness and flaccid paralysis (diaphragm is usually spared) Loss of reflexes Normal cranial nerves Normal sensory function Cardiovascular effects Hypotension[derangedphysiology.com]
  • Patients are frequently hemodynamically unstable, and as a result, they may experience syncope, hypotension, cardiovascular collapse, or death [ 2 ].[omicsonline.org]
  • Chloride 10% 5-10mL 3 x more potent than Calcium Gluconate Complication: severe thrombophlebitis Calcium Gluconate: Dose: Calcium Gluconate 10% 5-10mL Less potent, less irritating to veins Potential Complications of Calcium administration Bradycardia, hypotension[lifeinthefastlane.com]
Muscle Weakness
  • Careful monitoring of electrocardiogram changes and muscle weakness in hyperkalemia is important to determine its functional consequences. If these are observed to be severe, immediate correction of hyperkalemia is essential.[acls.com]
  • In most cases, this causes non-specific symptoms such as malaise , palpitations and muscle weakness and can only be detected with a blood test .[house.wikia.com]
  • Muscle weakness, poor appetite that does not improve. Feeling your heart beat rapidly (palpitations).[chemocare.com]
  • Muscle Weakness, Urine, Respiratory Distress, Decreased Cardiac Contractility, EKG Changes and Reflexes. Next thing I wanna talk about with hyperkalemia is the management AIRED, AIRED.[nrsng.com]
  • Sometimes people with hyperkalemia report nonspecific symptoms such as muscle weakness, tiredness, tingling sensations, or nausea .[emedicinehealth.com]
Flaccid Paralysis
  • In 94 patients, flaccid paralysis was described and in 25, severe muscular weakness; in 65 patients, these findings were associated with other symptoms. Concurrent renal failure was often documented.[ncbi.nlm.nih.gov]
  • In severe cases, weakness and flaccid paralysis may occur.[fpnotebook.com]
  • paralysis (diaphragm is usually spared) Loss of reflexes Normal cranial nerves Normal sensory function Cardiovascular effects Hypotension Bradycardia Biochemical abnormalities Normal anion gap metabolic acidosis (due to decreased renal ammoniagenesis[derangedphysiology.com]
  • Patients with moderate or severe hyperkalemia may also develop nervous symptoms such as tingling of the skin, numbness of the hands or feet, weakness, or a flaccid paralysis , which is characteristic of both hyperkalemia and hypokalemia (low plasma potassium[medical-dictionary.thefreedictionary.com]
Absent Deep Tendon Reflex
  • deep tendon reflexes Diagnosis Suspect hyperkalemia in ALL patients with renal impairment, especially end-stage renal disease (ESRD) Serum potassium Can be artificially elevated by extravascular hemolysis Blood gas results may differ from standard metabolic[coreem.net]
  • deep tendon reflexes When hyperkalemia is discovered, investigate potential pathophysiologic mechanisms.[emedicine.medscape.com]

Workup

  • Other testing is directed toward uncovering the condition or conditions that led to the hyperkalemia (see Workup).[emedicine.medscape.com]
Albuminuria
  • Here we examined the effect of patiromer treatment on serum aldosterone, blood pressure, and albuminuria in patients with chronic kidney disease on renin-angiotensin system inhibitors with hyperkalemia (serum potassium 5.1-6.5 mEq/l).[ncbi.nlm.nih.gov]
Left Axis Deviation
  • Left axis deviation. Absent P waves. Example 6 Hyperkalaemia: Sine wave appearance with severe hyperkalaemia (K 9.9 mEq/L). Example 7 Hyperkalaemia: Huge peaked T waves. Sine wave appearance.[lifeinthefastlane.com]
Potassium Increased
  • We identified 132 incidences of hyperkalemia induced by 8413 potentially severe potassium-increasing DDIs among 76 467 patients.[ncbi.nlm.nih.gov]
  • Preoperative serum potassium increased after parathyroidectomy with autotransplantation in patients with secondary hyperparathyroidism.[ncbi.nlm.nih.gov]
  • If serum potassium increases rapidly, cardiotoxicity will ensue. Reference: Rose BD, Post TW. Clinical Physiology of Acid-Base and Electrolyte Disorder, 5 th ed, McGraw-Hill, New York, 2001, pp. 383-396, 898-910. Squires RD, Huth EJ.[acls.com]
  • For every 0.1 unit decrease in blood PH, serum potassium increases by about 0.6 mmol/L (less if the acidosis is caused by organic acids) [2].[escardio.org]
Insulin Increased
  • Meanwhile, in respiratory acidosis , the effect on serum potassium level is small through an unknown mechanism. [12] The hormone insulin increases the uptake of potassium into the cells. Therefore, insulin deficiency can cause hyperkalemia.[en.wikipedia.org]
Wide QRS Complex
  • Although MMA is a rare complication, the possibility of severe hyperkalemia should be considered in the differential diagnosis of patients with MMA presenting with wide QRS complex tachycardia.[ncbi.nlm.nih.gov]
  • Electrocardiogram (ECG) showed a pacemaker (PMK)-induced rhythm, with loss of atrial capture and wide QRS complexes.[ncbi.nlm.nih.gov]
  • ., prolonged PR interval, wide QRS complex) as an alternative to 10 units of short acting insulin.[ncbi.nlm.nih.gov]
  • At least think of hyperkalemia if you see this combination of wide qrs complexes and tall T waves.[acadoodle.com]
Prolonged PR Interval
  • ., prolonged PR interval, wide QRS complex) as an alternative to 10 units of short acting insulin.[ncbi.nlm.nih.gov]
  • PR interval, prolonged QRS interval, loss of P wave, sine waves and finally ventricular fibrillation (see ECG guideline for normal values for age) ECG CHANGES DO NOT NECESSARILY PROGRESS IN ORDER OF SERIOUSNESS OR SEVERITY, IN RELATION TO THE SEVERITY[starship.org.nz]
  • Notes The classic ECG progression in hyperkalemia is: Peaked T waves Prolonged PR interval and flattening of the P wave Widening of the QRS Sine wave However. you cannot rely on the ECG to rule out significant hyperkalemia.[first10em.com]
  • PR interval AV block sine wave ventricular fibrillation asystole However, the sensitivity of ECG changes is low, and severe elevation can be accompanied by a normal ECG.[sharinginhealth.ca]
  • ECG Examples Example 1 This ECG displays many of the features of hyperkalaemia: Prolonged PR interval. Broad, bizarre QRS complexes — these merge with both the preceding P wave and subsequent T wave. Peaked T waves.[lifeinthefastlane.com]
Peaking T Wave
  • There was no statistically significant correlation between peaked T waves and short-term adverse events (RR 0.77, 95% CI [0.35-1.70]).[ncbi.nlm.nih.gov]
  • An 82-year-old male patient who presented typical electrocardiographic indications of hyperkalemia, including the absence of P waves, prolongation of QRS complex, sinoventricular conduction, bradyarrhythmia and tall peaked T waves.[ncbi.nlm.nih.gov]
  • Laboratory tests showed hyperkalemia (6.6 mmol/L), peaked T wave and a corrected QT interval of 510 ms.[ncbi.nlm.nih.gov]
  • They manifested similar initial symptoms (vomiting), abnormal serum potassium ( 8.0 mmol/L), and EKG's with peaked T waves. Both patients were treated for hyperkalemia and recovered without complication.[ncbi.nlm.nih.gov]
  • A woman in her 40's was found down: Sinus rhythm with wide QRS at 133 ms and obvious Peaked T-waves with obvious hyperkalemia. But there is also significant ST elevation in V1-V3. Is there anterior STEMI? The K 8.1.[hqmeded-ecg.blogspot.com]
Electrocardiogram Change
  • Hemodialysis (HD) has been suggested as the definitive therapy for severe hyperkalemia in this population,although there is limited data regarding renal replacement options.We report a case of life-threatening hyperkalemia with electrocardiogram changes[ncbi.nlm.nih.gov]
  • The most frequent causes of hyperkalemia in elderly patients are discussed and electrocardiogram changes and arrhythmias in hyperkalemia are analyzed, as well as their treatment and prevention.[ncbi.nlm.nih.gov]
  • Treatments involve inducing potassium loss. 6-8 Electrocardiogram changes in hyperkalemia include a tall peaked T wave.[acls.com]
  • Acute treatments for hyperkalemia that is associated with electrocardiogram changes are well known, and include insulin and glucose, β-agonists, calcium and, if necessary, dialysis.[nature.com]
Electrical Alternans
  • The case highlights the importance of recognizing hyperkalemia, as potential triggers of the acquired Brugada sign with electrical alternans.[ncbi.nlm.nih.gov]

Treatment

  • New treatments for hyperkalemia in development may offer better efficacy, tolerability and safety profiles than do existing approved treatments.[ncbi.nlm.nih.gov]
  • The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT) aimed to evaluate the current knowledge pertaining to the emergency treatment of hyperkalemia.[ncbi.nlm.nih.gov]
  • Food and Drug Administration approval for the treatment of hyperkalemia in October 2015. A second potassium-binding resin, a zirconium cyclosilicate currently known as ZS-9, may provide yet another alternative to the archetypal treatment with SPS.[ncbi.nlm.nih.gov]
  • Recently, patiromer was approved by the FDA as the first new potassium binder for the treatment of hyperkalemia in over 50 years.[ncbi.nlm.nih.gov]
  • Each clinical trial stratified results by hyperkalemia severity and dosing; therefore, these were considered separate treatment groups in the meta-analysis.[ncbi.nlm.nih.gov]

Prognosis

  • Hyperkalemia Microchapters Home Patient information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Hyperkalemia from other Diseases Epidemiology and Demographics Risk Factors Screening Natural history, Complications and Prognosis[wikidoc.org]
  • Prognosis The prognosis for specifically correcting hyperkalemia is excellent. However, hyperkalemia is usually caused by kidney failure, an often irreversible and eventually fatal condition.[medical-dictionary.thefreedictionary.com]
  • […] and transient cause of hyperkalemia, the prognosis is excellent.[emedicine.medscape.com]
  • Prognosis Hyperkalaemia is an independent risk factor for death and most fatal cases are complicated by AKI. Prevention Much dangerous hyperkalaemia is iatrogenic.[patient.info]

Etiology

  • Although many causes of hyperkalemia exist, exogenous red blood cell transfusions are being recognized as the primary perioperative etiology.[ncbi.nlm.nih.gov]
  • The most common cause of hyperkalemia in older patients is that of iatrogenic medication-related etiology due to associated polymorbidity, polypharmacy and reduced reserve metabolic capacity.[ncbi.nlm.nih.gov]
  • Clinicians should recognize that hyperkalemia is one of the etiologies of the Brugada-like electrocardiographic pattern.[ncbi.nlm.nih.gov]
  • SHP should be considered in the differential diagnosis of neurologic signs and symptoms of uncertain etiology, especially in a subject with kidney failure or who is taking medications that may worsen renal function.[ncbi.nlm.nih.gov]
  • Other less common etiologies of elevated potassium levels in the serum is pseudohyperkalemia resulting from thrombocytosis, leukocytosis or erythrocytosis.[cdemcurriculum.com]

Epidemiology

  • This review discusses the epidemiology, pathophysiology, and outcomes of hyperkalemia in heart failure; provides an overview of traditional and novel ways to approach management of hyperkalemia; and discusses the need for further research to optimally[ncbi.nlm.nih.gov]
  • Epidemiologic data demonstrate strong associations of morbidity and mortality in patients with hyperkalemia but these associations appear disconnected in certain patient populations and in differing clinical presentations.[ncbi.nlm.nih.gov]
  • Hyperkalemia Microchapters Home Patient information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Hyperkalemia from other Diseases Epidemiology and Demographics Risk Factors Screening Natural history, Complications[wikidoc.org]
  • Definition: A serum potassium level 5.5 mEq/L Epidemiology Common electrolyte disorder 10% of hospitalized patients ( Elliott 2010 ) Causes Pseudohyperkalemia: extravascular hemolysis Renal failure (potassium is primarily eliminated by the kidneys) Acidosis[coreem.net]
  • This was validated by comparison to a top-down, population and epidemiological-based analysis. As shown in Figure 2 , surveyed nephrologists reported that on average they see 29 patients per month, or approximately 350 per year with hyperkalemia.[lifescicapital.com]
Sex distribution
Age distribution

Pathophysiology

  • What is New: • KLHL3 & CUL3 are recently discovered genes helping unravel the pathophysiologic pathway of FHHt.[ncbi.nlm.nih.gov]
  • This review discusses the epidemiology, pathophysiology, and outcomes of hyperkalemia in heart failure; provides an overview of traditional and novel ways to approach management of hyperkalemia; and discusses the need for further research to optimally[ncbi.nlm.nih.gov]
  • In addition, we provide a comprehensive review of the literature concerning similar cases previously reported, as well as a discussion of the pathophysiology of mannitol-induced hyperkalemia.[ncbi.nlm.nih.gov]
  • Hyperkalemia Microchapters Home Patient information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Hyperkalemia from other Diseases Epidemiology and Demographics Risk Factors Screening Natural history, Complications[wikidoc.org]
  • Causes – Understanding normal metabolic homeostatic mechanisms helps define potential causative events that lead to disruption of the sensitive pathophysiological milieu.[lifeinthefastlane.com]

Prevention

  • The evidence needed to support a treatment claim (reduction in serum potassium) differs from that needed to support a prevention claim (preventing hyperkalemia to allow renin angiotensin aldosterone system inhibitor treatment).[ncbi.nlm.nih.gov]
  • The aim of this paper is to discuss strategies for prevention and management of hyperkalemia in patients with heart failure, including the role of novel therapies.[ncbi.nlm.nih.gov]
  • Severe hyperkalemia is a medical emergency, which requires immediate therapies, followed by interventions aimed at preventing its recurrence.[ncbi.nlm.nih.gov]
  • Future investigations are warranted to confirm the relationship between high FFK and PRCA and to observe the effectiveness of other interventions to prevent PRCA due to ECD-related hyperkalemia.[ncbi.nlm.nih.gov]
  • In order to prevent inappropriate ICD shock, consideration should be given to the suspension of ICD therapies while intensive care treatment of extreme electrolyte derangements is being pursued.[ncbi.nlm.nih.gov]

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Last updated: 2014-05-06 22:04