Feb 28, 2022
Contributor: Nick Tsipis, MD
- Acute hyperkalemia is characterized as serum K
of 5.4 or higher in non-hemolyzed samples
- Hyperkalemia is commonly associated with end
stage renal disease, acute kidney injury or acute renal
- Cardiac dysrhythmias are the primary concern
with hyperkalemia, common EKG changes (and approximate serum
levels) can include:
- Peaked T waves that start to show at serum K of
- Second sign is lengthening of PR and QRS
intervals due to extended repolarization
- Severe hyperkalemia manifests as a sine wave
around serum of 8-9
- Three approaches to treat
- Stabilize cardiac membrane with
- Shift potassium back into the cell,
insulin and albuterol are common agents used.
- Potassium binding for
- Cochrane review showed no significant effects
of Kayexalate on serum K in 4 hours
- Bowel necrosis is a rare adverse event that can
occur with Kayexalate
- More myths and misconceptions about
hyperkalemia addressed in reference below!
Gupta AA, Self M, Mueller M,
Wardi G, Tainter C. Dispelling myths and misconceptions about the
treatment of acute hyperkalemia. Am J Emerg Med. 2022;52:85-91.
Mahoney BA, Smith WA, Lo DS,
Tsoi K, Tonelli M, Clase CM. Emergency interventions for
Database Syst Rev.
2005;2005(2):CD003235. Published 2005 Apr 18.
Li T, Vijayan A. Insulin for the
treatment of hyperkalemia: a double-edged sword?.
Summarized by Mason Tuttle|
Edited by Nick Tsipis, MD