Patients with chronic hyperkalemia should be counseled to reduce dietary potassium. The goals of acute treatment are to prevent potentially life-threatening cardiac conduction and neuromuscular disturbances, shift potassium into cells, eliminate excess potassium, and resolve the underlying disturbance. Significant leukocytosis (> 75,000 cells per mm 3 ) Sodium polystyrene sulfonate (Kayexalate) may be effective in lowering total body potassium in the subacute setting.Īcute kidney injury/chronic kidney diseaseĪngiotensin-converting enzyme inhibitors and angiotensin receptor blockers Intravenous insulin and glucose, inhaled beta agonists, and dialysis are effective in the acute treatment of hyperkalemia. Intravenous calcium should be administered if hyperkalemic ECG changes are present. Intravenous potassium should be reserved for patients with severe hypokalemia (serum potassium 6.5 mEq per L ) ECG changes physical signs or symptoms possible rapid-onset hyperkalemia or underlying kidney disease, heart disease, or cirrhosis. Patients with a history of congestive heart failure or myocardial infarction should maintain a serum potassium concentration of at least 4 mEq per L (4 mmol per L). For both disorders, it is important to consider potential causes of transcellular shifts because patients are at increased risk of rebound potassium disturbances. Insulin, usually with concomitant glucose, and albuterol are preferred to lower serum potassium levels in the acute setting sodium polystyrene sulfonate is reserved for subacute treatment. To prevent cardiac conduction disturbances, intravenous calcium is administered to patients with hyperkalemic electrocardiography changes. Hypokalemia is treated with oral or intravenous potassium. Indications for urgent treatment include severe or symptomatic hypokalemia or hyperkalemia abrupt changes in potassium levels electrocardiography changes or the presence of certain comorbid conditions. Therefore, a first priority is determining the need for urgent treatment through a combination of history, physical examination, laboratory, and electrocardiography findings. When severe, potassium disorders can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction. Diuretic use and gastrointestinal losses are common causes of hypokalemia, whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemia. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts.
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