HYPERKALEMIA
Definition:
It
is defined as an elevation of serum potassium level greater than 5mEq/L.
Mostly
affects more than half of people with acute and chronic renal failure.
Etiology
1)Excessive
potassium intake:
·
Excessive
or rapid parenteral administration
·
Potassium
containing drugs( Potassium penicillin)
·
Potassium
containing salt substitute
2)Shift
of potassium out of cells
·
Acidosis
·
Tissue
catabolism
·
Crash
injury
·
Tumor
Lysis syndrome
3)Failure
to eliminate potassium
·
Renal
disease
·
Potassium
sparing diuretics
·
Adrenal
insufficiency
·
ACE
inhibitors
Clinical features
Initially:
·
Cramping
leg pain, followed by weakness or paralysis of skeletal muscles.
·
Disturbances
in cardiac conduction
·
Flattening
of the P wave and widened QRS complex, short QT interval and narrow and peaked T wave.
·
Abdominal
cramping and diarrhoea
Other symptoms:
·
Irritability,
Anxiety, Weakness of lower extremities, Paresthesia, Irregular pulse
Severe cases
·
Convulsions
and neuromuscular weakness progressing to flaccid paralysis and respiratory
muscle paralysis, Cardiac arrest
Diagnosis
·
History
and physical examination.
·
Blood
and urine studies.
·
Plasma electrolytes, creatinine, blood urea nitrogen and bicarbonate
levels.
·
Elevated BUN and plasma creatinine levels
·
ABG
analysis.
·
ECG
MANAGEMENT
It
depends on the degree of hyperkalemia as determined by the plasma K+
concentration, associated muscle weakness and changes on the ECG.
MEDICAL MANAGEMENT:
The
goals of the medical management are to correct the potassium level as quickly
as possible to prevent life threatening complications
Mild Hyperkalemia:
·
If
the plasma potassium level is less than 5.5mEq/L, dietary restriction of
potassium may be all needed.
·
Improving
the urine output by forcing fluids, giving IV saline, or giving potassium wasting
diuretics usually corrects mild hyperkalemia.
Severe Hyperkalemia:
·
Infusion
of 10 ml of 10% Calcium gluconate IV over 5min to decrease the antagonistic
effect of the potassium excess on the myocardium.
·
Infusion
of regular Insulin with 50% Glucose IV.
·
B2
agonist (Albuterol) nebulization - temporarily pushes potassium into the cell.
·
Sodium
bicarbonate to correct acidosis.
·
Beta
adrenergic agonist- ( Epinephrine) Rarely used.
Persistent
Hyperkalemia:
·
Sodium
polystyrene sulfonate: A resin that binds Potassium in the GI tract may be
given orally or rectally.
·
In
marked renal failure, peritoneal dialysis or hemodialysis may be needed.
NURSING MANAGEMENT:
Assessment
History and physical examination
Nursing diagnosis
·
Hyperkalemia
related renal dysfunction or burns, traumatic injuries.
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