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REGUB Path - Disorders of Potassium Balance (iii) Hyperkalaemia (Tx…
REGUB Path - Disorders of Potassium Balance (iii) Hyperkalaemia
K serum level > 5.4 mmol/L
3 sources
increased uptake
unusual cause of hyperkal without concurrent renal failure
salt substitutes (use K instead of Na)
TPN
enteral supplements
blood transfusions
high K foods
penicillin (in large doses can reduce renal K excretion)
dialysate (fluid used in dialysis)
extracellular shift
unusual cause of sustained hyperkalaemia without concurrent renal failure
hyperosmolality (hypertonic ECF - water moves out of cells, contains K)
DKA (H+ in K+ out)
hyperglycaemia
cell destruction
rhabdomyolysis (death of muscle fibres)
tumour lysis syndrome
drugs: B blockers, digoxin, succinylcholine (general anaesthesia)
acidemia
decreased renal excretion
renal failure (GFR<20 ml/min)
hypoaldosteronism
congenital adrenal insufficiency (Addison's disease)
DM (hyporenin)
ACEi
ARBs
renini
heparin
ketoconazole
K-sparing diuretics (spironolactone, amiloride, triamterene)
trimethoprim (blocks ENaC)
renal tubular acidosis types 1+4
Gordon's syndrome (pseudohypoaldosteronism type 2): AD, causes Cl shunt (less -ve)
Consequences
muscle weakness/paralysis
ECG changes + arrhythmia
increased extracellular K reduces myocardial excitability (depression of pacemaking + conducting tissues)
suppression of SA node, AV node conduction + His-Purkinje system
Tx
goal = prevent arrhythmia
Ca2+ (stabilises cardiac membranes)
Stop K intake (incl IV fluids, enteral feeds, parenteral nutrition, dialysate, antibiotics, blood products)
induce intracellular K shift
digoxin antidotes for digoxin toxicity
albuterol (inhaled B agonist)
IV insulin
sodium bicarb ineffective
increase renal excretion
diuretics
fludrocotisone (aldosterone analogue)
polystyrene resins
dialysis