K Potassium (3.5-5) > 5

• 6.5 = administer IV Ca regardless of ECG changes

• 7 = life-threatening

Untitled

Presentation

• Muscle Weakness
• Rigidity (Muscle Stiffness)
• Hyperkalemia (↑ K+) ECG :
  • Slow HR, wide QRS, acute T wave

Etiology + Investigation

1. Too much intake + CKD
2. Extracellular shift
   • Insulin deficiency → Random Glucose (2.5 - 6)
     • T1DM
     • !DKA - Diabetic KetoAcidosis
   • Cellular damage → CK, Haptoglobin , LDH, Uric acid, Peripheral Blood Film , other electrolyte
     • !Rhabdomyolysis
     • !Hemolysis
     • !TLS - Tumor lysis syndrome
     • !MH - Malignant Hyperthermia
3. Failure of renal excretion
   • Low flow to CCD → Volume Status Exam, other electrolyte, sCr (60-100 umol/L) , AKI investigation
     • ECFVD - Volume depletion
     • Severe AKI → !Renal Failure
   • Low Aldosterone → AM Cortisol level morning (high/normal = r/o)
     • Adrenal diseases (rare) → e.g. ↓Adrenal Insufficiency (Addison’s)
     • MRA, ARB, ACEi (RAA suppression)
4. Medications Causes
   • ACEi(-pril) (e.g., Ramipril)
   • ARB (-sartan) (e.g., Valsartan)
   • MRA → Spironolactone (potassium-sparing diuretic)
   • TMP-SMX (Septra) (antibiotic)
   • Amiloride

Acute Treatment (In patient)

• Algorithm for Urgency of Tm

No ECG Changes, K < 6.5 mmol:

1. Treat the underlying causes (e.g. pause Septra)
2. Decrease TBK

ECG Changes, or K > 6.5 mmol: