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Clinical manifestations of hyperkalemia

Clinical manifestations of hyperkalemia. Parham W. et.al. (2006). Hyperkalemia Revisited. Tex Heart Inst J. 33(1):40-47. Clinical manifestations of hyperkalemia. hyperkalemia partially depolarizes the cell membrane.

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Clinical manifestations of hyperkalemia

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  1. Clinical manifestations of hyperkalemia Parham W. et.al. (2006). Hyperkalemia Revisited. Tex Heart Inst J. 33(1):40-47

  2. Clinical manifestations of hyperkalemia • hyperkalemiapartially depolarizes the cell membrane. • Prolonged depolarization impairs membrane excitability and is manifest as weakness, which may progress to flaccid paralysis and hypoventilation if the respiratory muscles are involved

  3. Clinical manifestations of hyperkalemia Metabolic Acidosis • Hyperkalemia inhibits renal ammoniagenesis and reabsorption of NH4+ in the TALH • Net acid excretion is impaired and results in metabolic acidosis =15 Hyperglycemia400 mg/dL (300≈DKA) Acid anion - acetoacetate

  4. Management • Calcium gluconate↓membrane excitability • 10 mL of 10% solution infused over 2-3 min • Effect seen ECG after 5-10 min (if not-repeat dose) • Insulin for K+ shift into cells • 10-20 units regular insulin • Fall by 0.5-1.5 mmol/L in 15-30 min

  5. Management (DKA) • Replace fluids: • 2-3L of 0.9% saline over first 1-3h; • subsequently, 0.45% saline at 150-300 mL/h; • change to 5% glucose and 0.45% saline at 100-200mL/h when plasma glucose reaches 250 mg/dL • Short-acting insulin:IV (0.1 u/kg) • then 0.1 u/kg/h by continuous IV infusion • Monitor glucose q1-2h • electrolytes, anion gap q4h for 1st 24 h • Glucose goal is 150-250 mg/dL • insulin dec 0.05-0.1u/kg/h

  6. Management • Dialysis • Intractable acidosis • Intractable electrolyte imbalance • Intoxication • Intractable volume overload • Intractable uremia

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