Podcast 759: Hyperkalemia and Myth of Kayexalate

<p><strong>Contributor: Nick Tsipis, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Acute hyperkalemia is characterized as serum K of 5.4 or higher in non-hemolyzed samples</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Hyperkalemia is commonly associated with end stage renal disease, acute kidney injury or acute renal failure</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Cardiac dysrhythmias are the primary concern with hyperkalemia, common EKG changes (and approximate serum levels) can include:</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Peaked T waves that start to show at serum K of 6 </span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Second sign is lengthening of PR and QRS intervals due to extended repolarization</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Severe hyperkalemia manifests as a sine wave around serum of 8-9</span></li> </ul> </li> </ul> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Three approaches to treat hyperkalemia:</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Stabilize cardiac membrane with calcium</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Shift potassium  back into the cell, insulin and albuterol are common agents used.</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Potassium binding for excretion </span></li> </ul> </li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Cochrane review showed no significant effects of Kayexalate on serum K in 4 hours</span></li> <li style="fon