Episode 74- An Expert Talks: Intricacies of Hyperkalemia Management


 

Episode Summary:

Not your average hyperkalemia episode! Jimmy Pruitt, host of the Pharm-So-Hard podcast, shares some pearls on hyperkalemia management

Show Notes:

Key Points:

“‘An Expert Talks: Intricacies of Hyperkalemia Management”:
– HyperK can cause muscle weakness, paralysis, cardiac conduction abnormalities/ arrhythmias (bradycardia, cardiac arrest, ventricular tachycardia/fibrillation), peaked T waves/ loss of P waves, and widening of the QRS interval. Remember that a normal EKG does not exclude significant hyperK and that EKG changes can happen at lower K levels (<5.5 mEq/L)
Calcium works by “stabilizing” the cardiac membrane by (in a nutshell) making the resting potential more negative and by increasing the threshold potential. We should see EKG normalization within minutes, but effects may only last 30-60 minutes, so re-dosing may be necessary. 1 g IV Ca chloride contains 3x more calcium than 1 g IV Ca gluconate (13.6 vs 4.6 mEq) and is preferred in emergent situations (EKG changes, peri-arrest)
Insulin works by driving K into cells by enhancing the activity of the Na-K-ATPase in skeletal muscle. It is given as 5-10 units (or 0.1 units/kg) IV regular insulin, with the 5 unit dose being optimal — do not give it subcutaneously. It can lower the K by ~1 mEq/ L and should start to work within 10-20 mins, peak at 30-60 mins, and last 4-6 hours (can repeat every 2-6 hours)
Glucose/dextrose (25-50 g IV) is mainly given with IV regular insulin to prevent hypoglycemia and can be held if BG is > ~200; it should not be used alone without IV regular insulin as a shifting agent
Albuterol works by shifting K into cells by enhancing the activity of the Na-K-ATPase. It is given as 10-20 mg nebulized over 10 minutes. It can lower the K by 0.5-1.5 mEq/L
Resins/ cation exchangers like patiromer, sodium zirconium cyclosilicate (SZC; Lokelma), and SPS (Kayexelate) bind K in the GI tract. These agents are typically used as a bridge to dialysis in patients without severe hyperK. They have minimal effect on K levels, lowering K by 0.37 mEq/L at four hours. SPS has been associated with intestinal necrosis and contains 1500 mg sodium for every 15 g dose
Sodium bicarbonate theoretically works by binding H+, causing the H/K pump to pull in K in exchange for an H– with minimal/no effects on the K level. Consider giving it as 150 meq/ L (isotonic) over 2-4 hours in patients with metabolic acidosis and use the 50 mEq amp of bicarb (hypertonic) if you have EKG changes
Loop diuretics increase K excretion in the urine. It is given as 40 mg IV furosemide BID or a continuous infusion. It will not be very effective for patients that do not make urine (use resins instead)
Hemodialysis– mostly indicated in patients who are already on HD or have CKD, in consultation with nephrology. It is preferred to the resins if the procedure can be performed ASAP
 
ER-Rx Episode 74

Please click HERE to leave a review of the podcast!


Leave a Reply

Your email address will not be published.

Recent Reviews/ Comments

“Love this podcast for anyone working in an ER or ICU. If you aren’t a pharmacist you will still get tons of useful information to improve your practice. Adis has a knack for finding a happy balance between explaining the pharmacokinetics and practical use for patients at the bedside. Highly recommend!”

–  NotAPharmacist, Apple Podcasts review 

“Perfect amount of knowledge in a great length to refresh ICU and ED topics. Explains concepts in an easy to understand fashion”

–  RxLaura, Apple Podcasts review

“I love listening to this podcast because I can listen to 1 or 2 on my way to work and it provides great info! As a paramedic, this podcast has really helped me understand the “why” we give certain meds.”

cresjr, Apple Podcasts review

“Ideal podcast to listen on the way to my shift. Learning points throughout!”

andmatjos, Apple Podcasts review

“I’m currently in my last year of pharmacy school […] I just happen to come across your podcast on YouTube as I was trying to find a good explanation regarding the misleading sulfa allergy in non-antibiotic sulfonamides. Your explanation was great. I can’t believe I’m only now finding out about your podcasts but please continue to make them for as long as you can. Prospective pharmacists, such as myself, really appreciate you taking the time to put such great educational content out there.”

– S.P., Pharmacy Student

“Adis does a wonderful job of gathering the evidence-based answers to the hard questions that we all get as pharmacists and putting them into a nice, neat package.”

– rebroush1, Apple Podcasts review

“This is a great podcast to listen to at work and is not too overwhelming and well put together. Highly recommended for anyone in healthcare, even outside of emergency medicine.”

Peelage, Apple Podcasts review

“Great reviews on drug-related topics with useful details on drug mechanisms, pharmacodynamics and administration considerations as well as data to support recommendations. Great for pharmacists, providers and learners!”

-JaayyZzee, Apple Podcasts review

“I found the topics very helpful. I have been recommending this show to pharmacy students and residents, who are also enjoying it.”

hvgjnfd, Apple Podcasts review

“As a PA, I found this very informative. I like that the episodes are short, making them easy to listen to on my way to and from work. Would love to hear more pediatric topics!”

-Pediatric PA, Apple Podcasts review

“Good podcast thats very informative for all healthcare providers. Very easy to listen to and enjoy.”

-Bradlley88, Apple Podcasts review