Lecture Notes: Hyperkalemia

Introduction

• Presenter: Professor D
• Topic: Hyperkalemia (Part of a series on fluids and electrolytes)
• Previous Topics Covered: Hypokalemia, Hyponatremia
• Recommendation: Watch the entire series for comprehensive understanding

Housekeeping

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Key Concepts on Hyperkalemia

Therapeutic Range

• Normal Potassium Range: 3.5 to 5 mEq/L
• Hyperkalemia: Potassium > 5 mEq/L
• Hypokalemia: Potassium < 3.5 mEq/L

Important Notes

• Cardiac Issues: Major concern with hyperkalemia
• Serum Potassium Impact:
  • Rapid rise (6-7 mEq/L) causes severe issues
  • Slow rise up to 8 mEq/L before issues occur
• Kidney Function: Vital for regulating potassium levels
  • Hyperkalemia is rare in patients with normal kidney function
  • At risk: Chronically ill, debilitated, older patients

Assessment and Questions

• Kidney Disease: History of renal issues
• Diabetes: Current status and treatments
• Recent Treatments: Medical or surgery history
• Urine Output: Volume and frequency of voiding

Symptoms to Ask About

• Cardiac: Palpitations, skipped heartbeats, irregularities
• Neuromuscular: Muscle twitching, leg weakness, paresthesia
• GI: Changes in bowel habits, especially diarrhea

Medications

• Potassium-sparing diuretics: e.g., Spironolactone
• ACE inhibitors: Can increase potassium
• Salt Substitutes: Often high in potassium

Cardiovascular Changes

• Symptoms and Complications:
  • Bradycardia
  • Hypotension
  • ECG Changes: Tall peaked T waves, prolonged PR intervals, flat/absent P waves, wide QRS complexes
  • Life-Threatening: Complete heart block, asystole, ventricular fibrillation

Neuromuscular Changes

• Early Stages: Muscle twitching and irritation, paresthesia
• Advanced Stages: Muscle weakness, flaccid paralysis
• Respiratory Muscles: Affected only at lethal potassium levels

Intestinal Changes

• Hyperkalemia: Increased motility, diarrhea, hyperactive bowel sounds
• Hypokalemia: Decreased motility, constipation, paralytic ileus

Lab Data

• Potassium Levels: > 5 mEq/L signifies hyperkalemia

Interventions

Drug Therapy

• Priorities:
  • Assess for cardiac complications
  • Ensure patient safety
  • Monitor response to therapy
• Actions:
  • Stop potassium-containing infusions
  • Keep IV access open
  • Withhold potassium supplements
  • Implement potassium-restricted diet
  • Consider dialysis if levels are dangerously high
  • Administer IV fluids with glucose and insulin

Special Considerations

• Insulin and Potassium: Insulin lowers potassium levels but risks hypokalemia and hypoglycemia
• Cardiac Monitoring: Continuous monitoring necessary
• Critical Rescue: Notify if heart rate < 60 bpm or T waves become spiked

Health Teaching and Prevention

• Dietary Instructions: Avoid high-potassium foods
• Medication Guidance: Adherence to prescribed medications
• Symptom Recognition: Early detection of hyperkalemia symptoms

Foods to Avoid

• High in Potassium:
  • Meat, organ meats, preserved meats
  • Dairy products, dry fruits
  • Fruits: bananas, cantaloupe, kiwi, oranges
  • Vegetables: avocados, broccoli, potatoes, spinach

Conclusion

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