Contributor: Nick Tsipis, MD
Educational Pearls:
- Acute hyperkalemia is characterized as serum K of 5.4 or higher in non-hemolyzed samples
- Hyperkalemia is commonly associated with end stage renal disease, acute kidney injury or acute renal failure
- Cardiac dysrhythmias are the primary concern with hyperkalemia, common EKG changes (and approximate serum levels) can include:
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- Peaked T waves that start to show at serum K of 6
- Second sign is lengthening of PR and QRS intervals due to extended repolarization
- Severe hyperkalemia manifests as a sine wave around serum of 8-9
- Three approaches to treat hyperkalemia:
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- Stabilize cardiac membrane with calcium
- Shift potassium back into the cell, insulin and albuterol are common agents used.
- Potassium binding for excretion
- Cochrane review showed no significant effects of Kayexalate on serum K in 4 hours
- Bowel necrosis is a rare adverse event that can occur with Kayexalate
- More myths and misconceptions about hyperkalemia addressed in reference below!
