UC-Irvine Internal Medicine Mini-Lecture Series

UC-Irvine Internal Medicine Mini-Lecture Series www.phwiki.com

UC-Irvine Internal Medicine Mini-Lecture Series

Parham, Maria, Features Editor has reference to this Academic Journal, PHwiki organized this Journal CLINICAL DIAGNOSIS AND APPROACH TO HYPERKALEMIA UC-Irvine Internal Medicine Mini-Lecture Series Objectives 1. Underst in addition to diagnosis of hyperkalemia based on clinical data 2. Underst in addition to ECG changes present in hyperkalemic states 3. Underst in addition to treatment/therapy approaches available as long as hyperkalemia Clinical Scenario A 52-year-old man with hypertension in addition to diabetes complains of weakness, nausea, in addition to a general sense of illness, that has progressed slowly over 3 days. His medications include a sulonylurea, a diuretic, in addition to an ACE inhibitor. On examination, he appears lethargic in addition to ill. His BP is 154/105 mm Hg, HR 70bpm, temperature 98.6° F, in addition to respiratory rate 22 breaths/min. The physical examination reveals moderate jugular venous distension, some minor bibasilar rales, in addition to lower extremity edema. He is oriented to person in addition to place but is able to give further history. The ECG shows a wide complex rhythm. Laboratory studies per as long as med are significant as long as potassium 7.8 mEq/L, BUN is 114 mg/dL in addition to creatinine is 10.5.

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Diagnostics/Images: ECG ECG Changes of Hyperkalemia Easily Distinguished ECG signs: peaked T wave. prolongation of the PR interval ST changes (which may mimic myocardial infarction) very wide QRS, which may progress to a sine wave pattern in addition to asystole. Patients may have severe hyperkalemia with minimal ECG changes, in addition to prominent ECG changes with mild hyperkalemia. Analysis Diagnosis: Hyperkalemia- Severe Classification of Hyperkalemia NORMAL: 3.5 to 5.0 mEq/L. MILD: 5.5 to 6.0 mEq/L SEVERE: Levels of 7.0 mEq/L or greater It is important to suspect this condition from the history in addition to ECG, because laboratory test results may be delayed in addition to the patient could die be as long as e those test results become available.

Therapy Approach BIG K Drop B – beta agonists, bicarbonate I – Insulin G – Glucose K – Kayexulate, Calcium D – Diuretics, Dialysis 1st Line option Reference: Holl in addition to er JC, Calvert CJ. Hyperkalemia. Am Fam Physician 2006; 73:283-90, Figure 2.

Clinical Pearls Symptoms of hyperkalemia are usually nonspecific, so risk factors must be used to suspect the diagnosis ECG changes consistent with hyperkalemia should be treated immediately as a life-threatening emergency. Do not await laboratory confirmation. Intravenous calcium is the antidote of choice as long as life-threatening arrhythmias related to hyperkalemia, but its effect is brief in addition to additional agents must be used Comprehension Questions QUESTION 1: A 55-year-old man presents in cardiac arrest. A dialysis fistula is present in the right arm. In addition to st in addition to ard ACLS therapies, which of the following is most appropriate as long as this patient A. 25 g of 50% dextrose, IV push. B. Sodium bicarbonate, 50-mL IV push. C. Begin immediate hemodialysis. D. Calcium gluconate, slow intravenous push. QUESTION 2: A 45-year-old man is brought into the emergency center due to significant dehydration in addition to weakness. His potassium level is noted to be 7 mEq/L. Which of the following statements is most accurate regarding his potassium level A. Hyperkalemia can usually be diagnosed by symptoms alone. B. An ECG showing peaked T waves means the patient is stable in addition to treatment can safely wait until laboratory results are obtained. C. Hyperkalemia can mimic a myocardial infarction on the ECG. D. Hyperkalemia is synonymous with kidney disease. Comprehension Questions QUESTION 3: Which of the following statements regarding treatment of hyperkalemia in patients with some renal function is incorrect A. Administration of normal saline may hasten the excretion of potassium. B. Administration of furosemide can hasten the excretion of potassium. C. The combination of saline with a diuretic is often indicated because hyperkalemic patients are frequently dehydrated. D. Patients with some renal function do not need dialysis even as long as severe hyperkalemia. QUESTION 4: A patient with severe renal disease is found to have hyperkalemia, with tall, peaked T waves on ECG. Vascular access cannot be readily obtained, but vital signs are stable. Which of the following would be appropriate temporizing measures A. Inhaled albuterol 2.5 mg in 3 mL saline B. Oral sodium bicarbonate with rectal sodium polystyrene sulfonate C. Inhaled albuterol 20 mg, with oral or rectal sodium polystyrene sulfonate, 30 g D. Oral dextrose 25 g

References Evans KJ, Greenberg A. Hyperkalemia: a review. J Intensive Care Med. 2005 Sep-Oct;20(5):272-290. Kamel KS, Wei C. Controversial issues in the treatment of hyperkalaemia. Nephrol Dial Transplant. 2003;18:2215-2218. Sood MM, Sood AR, Richardson R. Emergency management in addition to commonly encountered outpatient scenarios in patients with hyperkalemia. Mayo Clin Proc. 2007 Dec; 82(12):1553-1561. Holl in addition to er JC, Calvert CJ. Hyperkalemia. Am Fam Physician 2006; 73:283-90

Parham, Maria Arizona Daily Star Features Editor www.phwiki.com

Parham, Maria Features Editor

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