HYPERKALEMIA
INTRODUCTION
Hyperkalemia (elevated potassium levels) can be subtle but life-threatening. It can result from many conditions. Most commonly it is found in end-stage kidney failure patients on dialysis. But it can occur in patients taking excessive potassium through diet or medications, crush injuries and compartment syndrome, burns, and acidosis such as sepsis or diabetic ketoacidosis. There are much rarer times when electrolytes become disrupted by severe diarrhea and prolonged heat exposure.
Symptoms are often vague and include weakness, fatigue, confusion, lethargy, and EKG changes including bradycardia.
TREATMENT GUIDELINE
General
1. Cardiac monitor
2. 12-lead EKG that should be repeated often
3. Monitor patient’s vitals closely and be prepared for potential deterioration including cardiac arrest.
INTERMEDIATE
1. Establish IV/IO and bolus 10 cc./kg. of Normal Saline or Lactated Ringers if patient is hypotensive and unstable. Repeat as indicated.
PARAMEDIC
1. Examine EKG for possible changes. See samples at the end of this protocol.
2. Mild hyperkalemia
a. Peaked T waves, increase in PR interval, decrease in P wave amplitude. Symptomatic.
b. ALBUTEROL 15 mg. by nebulizer.
3. Moderate to Severe
a. Loss of P wave, widening of QRS, in severe cases the QRS-T wave can become a sine wave. Bradycardia. Symptomatic.
b. ALBUTEROL 15 mg. by nebulizer. May repeat if patient remains unstable.
c. CALCIUM CHLORIDE Adult: 1 gram IV/IO over 10 minutes. Pediatric: 20 mg/kg IV/IO over 10 minutes. Maximum is 1 gram.
d. CALCIUM GLUCONATE Adult: 3 grams IV/IO over 10 minutes. Pediatric: 60 mg/kg IV/IO over 10 minutes. Maximum is 3 grams.
e. SODIUM BICARBONATE Adult: 50 mEq IV/IO q 3-5 minutes until QRS narrows. Pediatric: 1 mEq/kg q 3-5 minutes IV/IO until QRS narrows.
f. Reminder: Don’t mix Calcium and Sodium Bicarbonate in the same IV/IO.
g. EKG changes as hyperkalemia worsens from peaked T waves to sine wave.
INTRODUCTION
Hyperkalemia (elevated potassium levels) can be subtle but life-threatening. It can result from many conditions. Most commonly it is found in end-stage kidney failure patients on dialysis. But it can occur in patients taking excessive potassium through diet or medications, crush injuries and compartment syndrome, burns, and acidosis such as sepsis or diabetic ketoacidosis. There are much rarer times when electrolytes become disrupted by severe diarrhea and prolonged heat exposure.
Symptoms are often vague and include weakness, fatigue, confusion, lethargy, and EKG changes including bradycardia.
TREATMENT GUIDELINE
General
1. Cardiac monitor
2. 12-lead EKG that should be repeated often
3. Monitor patient’s vitals closely and be prepared for potential deterioration including cardiac arrest.
INTERMEDIATE
1. Establish IV/IO and bolus 10 cc./kg. of Normal Saline or Lactated Ringers if patient is hypotensive and unstable. Repeat as indicated.
PARAMEDIC
1. Examine EKG for possible changes. See samples at the end of this protocol.
2. Mild hyperkalemia
a. Peaked T waves, increase in PR interval, decrease in P wave amplitude. Symptomatic.
b. ALBUTEROL 15 mg. by nebulizer.
3. Moderate to Severe
a. Loss of P wave, widening of QRS, in severe cases the QRS-T wave can become a sine wave. Bradycardia. Symptomatic.
b. ALBUTEROL 15 mg. by nebulizer. May repeat if patient remains unstable.
c. CALCIUM CHLORIDE Adult: 1 gram IV/IO over 10 minutes. Pediatric: 20 mg/kg IV/IO over 10 minutes. Maximum is 1 gram.
d. CALCIUM GLUCONATE Adult: 3 grams IV/IO over 10 minutes. Pediatric: 60 mg/kg IV/IO over 10 minutes. Maximum is 3 grams.
e. SODIUM BICARBONATE Adult: 50 mEq IV/IO q 3-5 minutes until QRS narrows. Pediatric: 1 mEq/kg q 3-5 minutes IV/IO until QRS narrows.
f. Reminder: Don’t mix Calcium and Sodium Bicarbonate in the same IV/IO.
g. EKG changes as hyperkalemia worsens from peaked T waves to sine wave.