Hyperkalemia Overview

Introduction

• Presenter: Sarah from Register Nurse RN
• Subject: Overview of hyperkalemia
• Objective: Provide key points for lecture exams and the NCLEX
• Recommendation: Take the accompanying quiz on register nurse rn.com

Definition and Terminology

• Hyperkalemia: High potassium in the blood
  • Breakdown:
    • Hyper: Excess, high
    • Kal: Potassium
    • Emia: Blood
• Normal Potassium Levels:
  • 3.5 to 5.1 mEq/L (some references: 3.4 to 5.2 mEq/L)
  • Levels >7 mEq/L are dangerous

Pathophysiology

• Potassium primarily resides intracellularly, but high levels in the extracellular fluid (blood) indicate hyperkalemia
• Responsible for nerve conduction and muscle contraction

Causes of Hyperkalemia (CARED)

• C: Cellular movement (Intracellular to Extracellular)
  • Causes: Burn injuries, tissue damage, acidosis
• A: Adrenal insufficiency
  • Seen in Addison’s disease
• R: Renal failure
  • Common in dialysis patients
• E: Excessive potassium intake
  • Over-supplementation, diuretics
• D: Drugs
  • Potassium-sparing diuretics (e.g., Aldactone, Triamterene)
  • ACE inhibitors, NSAIDs

Signs and Symptoms (MURDER)

• M: Muscle weakness
• U: Urine output low or absent (renal failure)
• R: Respiratory failure
• D: Decreased cardiac contractility (weak pulse, low BP)
• E: Early signs (muscle twitching, cramps), late sign (profound weakness)
• R: Rhythm changes in EKG (e.g., tall peaked T-waves, flat P-waves, wide QRS complexes)

EKG Changes in Hyperkalemia

• Normal EKG: P wave, QRS complex, T wave
• Hyperkalemia EKG:
  • Tall peaked T-waves
  • Flat/absent P-waves
  • Wide QRS complexes
  • Prolonged PR interval
• Memory aid: Hyperkalemia = exaggerated EKG features

Interventions

• Monitor cardiac, respiratory, neuro, muscular, and GI status
• Stop IV potassium infusions and hold PO supplements
• Initiate potassium-restrictive diet
  • Foods high in potassium include potatoes, pork, oranges, tomatoes, avocados, strawberries, spinach, fish, mushrooms, muskmelon, carrots, raisins, bananas
• Prepare for dialysis
• Use medications like Kayexalate (enema), Lasix (furosemide)
• Administer hypertonic glucose and insulin solutions to shift potassium intracellularly

Conclusion

• Encouragement to review the material and take the website quiz
• Additional resources: Other teaching tutorials and subscription to Register Nurse RN YouTube channel