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
· Tissue catabolism
· Crash injury
· Tumor Lysis syndrome
3)Failure to eliminate potassium
· Renal disease
· Potassium sparing diuretics
· Adrenal insufficiency
· ACE inhibitors
· 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
· Irritability, Anxiety, Weakness of lower extremities, Paresthesia, Irregular pulse
· 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.
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
· 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.
· 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.
· 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
· Hyperkalemia related renal dysfunction or burns, traumatic injuries.