Hyperkalemia Lecture Notes

Introduction

• Presenter: Sarah from Register Nurse RN
• Topic: Hyperkalemia (high potassium in the blood)
• Related topic: Hypokalemia (covered in a previous video)
• Recommended resources: RegisterNurseRN.com for quizzes and additional resources.

Understanding Hyperkalemia

• Definition: Excessively high potassium levels in the blood.
• Normal Potassium Levels: 3.5 to 5.1 mEq/L (varies slightly by source).
• Dangerous Levels: Levels above 7 mEq/L require fast intervention.

Cellular Level Explanation

• Potassium is primarily intracellular.
• Blood tests measure extracellular potassium.
• Hyperkalemia: Excess potassium moves from cells into blood.

Function of Potassium

• Responsible for nerve conduction and muscle contraction.
• Excess potassium disrupts these functions.

Causes of Hyperkalemia

• C.A.R.E.D mnemonic:
  • C: Cellular movement from intracellular to extracellular (e.g., burns, tissue damage, acidosis).
  • A: Adrenal insufficiency (e.g., Addison's disease).
  • R: Renal failure (common in dialysis patients).
  • E: Excessive intake (supplements, diet).
  • D: Drugs (potassium-sparing diuretics, ACE inhibitors, NSAIDs).

Signs and Symptoms

• M.U.R.D.E.R mnemonic:
  • M: Muscle weakness.
  • U: Urine output reduction (especially in renal failure).
  • R: Respiratory failure (due to muscle and nerve dysfunction).
  • D: Decreased cardiac contractility (weak pulse, low BP).
  • E: Early signs - muscle twitching/cramps; late signs - profound weakness.
  • R: Rhythm changes (tall T-waves, flat P-waves, wide QRS complexes, prolonged PR interval).

EKG Changes

• Normal EKG:
  • P wave, QRS complex, T wave.
• Hyperkalemia EKG:
  • Flat P waves, prolonged PR interval, wide QRS, tall T-waves.

Interventions

• Monitoring: Cardiac, respiratory, neurological, muscular, and GI status.
• Treatment Actions:
  • Stop IV potassium and hold supplements.
  • Start potassium-restricted diet.
  • Prepare for dialysis if required.
  • Use Kayexalate (sodium polystyrene sulfonate) to promote potassium excretion.
  • Administer potassium-wasting diuretics (e.g., Lasix).
  • Use hypertonic glucose and insulin to shift potassium back into cells.

Dietary Considerations

• Potassium-rich Foods: Potatoes, pork, oranges, tomatoes, avocados, strawberries, spinach, fish, mushrooms, muskmelon, carrots, raisins, bananas.
• Important for hypokalemia management (encourage) and hyperkalemia (restrict).

Conclusion

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