POTASSIUM EXCESS (HYPERKALEMIA)

_____________________ (mmol/L)
Often caused by ________(treatment-
induced) causes.
Less common but more dangerous
Cardiac arrest more frequent associated
with _____________________.
PATHOPHYSIOLOGY
Three major causes of HYPERKALEMIA:
1. Renal excretion of potassium
2. Rapid administration of potassium
3. ________________________________
________________________________

Medications that contributes > 60% of
hyperkalemic episodes:
Potassium Chloride
Heparin
ACE inhibitors
NSAIDS
Beta-blockers
Potassium-sparing Diuretics

Potassium regulation is compromised in an
acute and chronic RF, w/ GFR <10-20% of
normal.

Improper use of potassium
supplements predisposes all pts to
hyperkalemia, esp. if salt substitutes are
used.
________________________________
________________________________
________________________________.
Not all pts receive potassium-
conserving diuretics should not receive
supplements.

Potassium supplements are extremely
dangerous to pts who have impaired renal
fx thus decreased ability to excrete
potassium.
More dangerous is the IV administration,
bec. Serum levels can rise very quickly.
________ (stored) blood should not be
administered, bec. Potassium concentration
of stored blood increases due
____________________________.
It is possible to exceed the renal tolerance
of any patient with rapid IV potassium
administration, as well as when large
amounts of oral potassium supplements are
ingested.
____________, potassium moves out of the
cells and into the ECF.
PSEUDOHYPERKALEMIA (variation of
hyperkalemia) caused by:
Tight tourniquet around an exercising
extremity while drawing a blood sample
Marked leukocytosis
Thrombocytosis
Drawing blood into the site where
potassium is infusing.
Familial pseudohyperkalemia
Knowledge deficit

CLINICAL MANIFESTATIONS
6 mEq/L (6mmol/L)
Peaked, narrow T waves;
ST-segment depression
Shortened QT interval
If continues to increase:
PR interval prolong
Disapearance of P waves
Finally, decomposition and widening of
QRS complex
VENTRICULAR DYSRYTHMIAS AND
CARDIAC ARREST may occur at the
point of progression.
Severe hyperkalemia causes muscle
weakness and even paralysis r/t
depolarization block in muscle.
Rapidly ascending muscular weakness
leading to flaccid quadriplegia.
Paralysis of respiratory and speech
muscles
Nausea, intermittent intestinal colic,
and diarrhea.
ASSESSMENT AND DIAGNOSTIC FINDINGS
- Serum potassium levels
- ECG changesi
- ABG analysis reveals both metabolic
and respiratory acidosis.

MEDICAL MANAGEMENT
-ECG should be obtain immediately to detect
changes. (Reveals, shortened repolarization and
peaked T waves initially).
- verify results with repeat serum potassium
level from a vein w/out an IV infusing a
potassium-containing solution.
- NONacute: restriction of dietary potassium
and potassium-containing medications.
- Administration either orally, or enema (of
cation exchange renin). Ex. Sodium
polystyerene sulfonate (kayexalate)
- contraindicated with patient with paralytic
ileus bec. Intestinal perforation can occur.
- It binds with other cations in the GI tract w/c
causes hypomagnesemia, hypocalcemia.
- contraindicated with patients with heart
failure because it may cause sodium retention
and fluid overload.
EMERGENCY PHARMACOLOGIC THERAPY
- Administer IV calcium gluconate.
- Calcium gluconate contains ________
of calcium and Calcium chloride
contains __________ of calcium. Not
interchangeable and caution is
required.
- Monitor BP to detect ___________
which may result rapid IV
administration of calcium gluconate.
- ECG is monitored closely during the
administration, _________________ is
an indication to stop the infusion.
- IV administration of
_______________________ may be
necessary to alkalinize the plasma,
cause a temporary shift of potassium
into the cells, and furnish sodium to
antagonize the cardiac effects of
potassium into the cells, and furnish
sodium to antagonize the cardiac
potassium effect.
- IV administration of regular insulin and
hypertonic dextrose solution causes
temporary shift of potassium into the
cells.
- Loop diuretics (furosemide-Lasix), Beta-
2 agonists (Proventil, Ventolin),
- Actual removal of potassium from the
body through cation exchange resins,
peritoneal dialysis, hemodialysis, and
other renal replacement therapy.

NURSING MANAGEMENT
- Monitor closely for signs of
Hyperkalemia.
- Observe for _______________,
______________, _____________,
__________ and ______________.
- Monitor closely the serum potassium
levels, BUN, creatinine, glucose, arterial
blood gas values.
- Prevent Hyperkalemia.
o Encourage patient to adhere to
the prescribed potassium
restriction.
o Avoid potassium rich foods such
as fruits and vegetables, whole-
grain breads, meats, milk, eggs,
coffee, tea, and cocoa.
- Correcting Hyperkalemia
o Administer and monitor
potassium solutions closely.
o Particular attention is paid
closely to the solutions
concentration and rate of
administration.
o Caution patients to use salt
substitutes sparingly if they are
taking other supplementary
forms of potassium or
potassium-conserving diuretics.
o Potassium- conserving diuretics
and potassium supplements
should not be administered to
patients with renal dysfunction.