Hyperkalemia

Alodsteron effects on potassium

Aldosterone and Insulin push K+ inside the cell

Normal K

Normal K is 3.5-4.8

If a potassium sample is hemolyzed

you can get falsely high measure -Pseudohyperkalemia

Causes of hyperkalemia

→Renal insufficiency (GFR<30)

→Decreased aldosterone: ACEIs, ARBs

→Inhibitors of renal secretion of K+: Spironolactone, eplerenone , triamterene, amiloride, trimethoprim

Presentation of hyperkalemia

→Conduction disturbances on ECG at K>6.5

→T wave increase, Reduced P wave, Increased PR, increased QR

Strategy to avoid drug induced hyperkalemia

→Assess renal function

→DM, CHF, advanced age, multiple K+ meds - higher risk

→Reduce K+ intake

DO not add ACEI, ARB, spironolactone if K is

K>5

Recommend therapy for hyperkalemia

1)Physiological antagonism of membrane actions
→IV calcium if acute ECG disturbances

2)Intracellular shift with insulin, B2 agonist , sodium bicarb (if metabolic acidosis)

3)Removal from body with renal excretion: Loop/thiaizde diuretics, K binders, Dialysis

B2 agonists

(albuterol or terbutaline)

When to use sodium bicarb of hyperkalemia

if they also have metabolic acidosis

K binders

Kayexalate :Na polystyrene sulfonate (not preferred),

Veltassa: patiromer,

Lokelma: sodium zirconium cyclosilicate

Veltassa (Patiromer) pearls

avoid taking with other oral meds within 3 hours. Assess for hypomagnesemia

Lokelma- sodium zirconium cyclosilicate Pearls

increases warfarin statin conc

Decreases clopidogrel, dabigatran and tacrolimus conc

Does calcium affect serum K levels?

No- must use with other strategies

Are Veltassa or Lokelma FDA approved for emergency use?

No