BSN Notes: Common Signs And Symptoms: Hyperkalemia


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.
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
·         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
·         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
            It depends on the degree of hyperkalemia as determined by the plasma K+ concentration, associated muscle weakness and changes on the ECG.
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.
 History and physical examination  
Nursing diagnosis

·         Hyperkalemia related renal dysfunction or burns, traumatic injuries. 

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item BSN Notes: Common Signs And Symptoms: Hyperkalemia
BSN Notes: Common Signs And Symptoms: Hyperkalemia
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