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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, July 19, 2013

Hiperkalemia: revisión del tratamiento

Kidneynotes.com 2006
"Hyperkalemia is a common problem that can range in severity from inconsequential to life-threatening. The treatments for hyperkalemia also vary widely and can include simply restricting dietary potassium; administering oral, intravenous or inhaled medications; and providing emergent dialysis for more extreme elevations."

Life in The Fast Lane 2006
"Hyperkalaemia is a life-threatening emergency"

Parham W. et al. Tex Heart Inst J 2006; 33:40-47
"Hyperkalemia is a common clinical condition that can induce deadly cardiac arrhythmias. Electrocardiographic manifestations of hyperkalemia vary from the classic sine-wave rhythm, which occurs in severe hyperkalemia, to nonspecific repolarization abnormalities seen with mild elevations of serum potassium. We present a case of hyperkalemia, initially diagnosed as ventricular tachycardia, to demonstrate how difficult hyperkalemia can be to diagnose. An in-depth review of hyperkalemia is presented, examining the electrophysiologic and electrocardiographic changes that occur as serum potassium levels increase. The treatment for hyperkalemia is then discussed, with an emphasis on the mechanisms by which each intervention lowers serum potassium levels. An extensive literature review has been performed to present a comprehensive review of the causes and treatment of hyperkalemia." 

My Hyperkalemia 2013
  • MILD ELEVATION (eliminating): (-6 mEq/L): Furosemide / Kayexalate
  • MODERATE ELEVATIONS (shifting+eliminating): (6-7 mEq/L):  Glucose+Insulin / Albuterol / Sodium bicarbonate / (Furosemida / Kayexalate)
  • SEVERE ELEVATION (stabilization+shifting+eliminating):  (+7 mEq/l): Calcium chloride (or Gluconate) / Glucose+Insuline / Albuterol / Sodium bicarbonate / (Furosemide / Kayexalate) / (DIALISIS)
    • ECG is not always helpfull / Pick T waves are inespecific
    • Exists the risk of sudden arrithmias: always monitor the patient 
    • IV Calcium chloride can cause necrosis if infiltrated (use a central line or use Calcium gluconate peripheral)
    • Kayexalate is not very helpfull (and risk of intestinal necrosis)
    • Sodium bicarbonate works if the patient is acidotic
    • Calcium chloride has three times more Calcium than gluconate