Hyperkalemia

If a triage ECG is not done for your dialysis patient, that 10 second strip of paper should be at the top of your priority list - Maninder Singh

Hyperkalemia

image by: Rapid Sequence Interrogation - RSI Podcast

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Emergency Medicine Myth #3: Kayexelate in HyperK+, Useless? Harmful?

Hyperkalemia treatment is a core skill for emergency physicians and an area in which we excel. Give calcium to stabilize cardiac myocytes if there are ECG changes, insulin (plus dextrose), albuterol, and sodium bicarbonate to shift potassium into the cell, and then sodium polystyrene sulfonate (SPS; brand name Kayexalate) to eliminate the potassium from the body, right?

There are areas to debate within each of these steps, but I want to address the final one. SPS is a cation-exchange resin that was approved in 1958 as a treatment for hyperkalemia by helping to exchange sodium for potassium in the colon and excreting potassium from the body.

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Resources

 Emergency Medicine Myth #3: Kayexelate in HyperK+, Useless? Harmful?

Save your patient, yourself, and your nurses from dealing with the unpleasant after-effects of SPS (i.e., diarrhea) by avoiding this ineffective and potentially dangerous medication.

Core EM

Hyperkalemia can present with a number of “non-classic” EKG findings including AV blocks and sinus bradycardia (Mattu 2000).

EMCrit

If bicarbonate is low, resuscitate with isotonic bicarbonate (D5W with 150 mEq/L sodium bicarbonate, typically three 50-mEq amps of bicarb in a liter of D5W).

Life in the Fastlane

Cardiac arrest... don’t stop until K+ normalised.

SAEM

Obtain an ECG on patients with chronic kidney disease who present with generalized fatigue and weakness to quickly screen for hyperkalemia. Patients with no reason for hyperkalemia found incidentally should have the potassium level repeated to make sure hemolysis is not present. Calcium salts only stabilize the cardiac membrane and do nothing to lower the potassium level and further treatment is required to lower the potassium level.

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