Document 6475803

HYPERKALEMIA (Serum K+ >5.5mmol/L) *Obtain EKG and initiate Telemetry monitoring* Mild Hyperkalemia (5.5-­‐6.5mmol/L) Moderate Hyperkalemia (6.5-­‐7.5 mmol/L) Severe Hyperkalemia (>7.5 mmol/L) Asymptomatic Consider Kayexalate 0.5-­‐1 g/kg PO/PR Differential Diagnosis: 1) Lab error/Hemolysis 2) Impaired eliminationà a) renal failure (acute or chronic) b) medications interfering with urinary excretion c) hypoaldosteronism d) pseudohypoaldosteronism e) congenital adrenal hyperplasia f) congestive heart failure g) constipation 3) Increased shift extracellularlyà a) acidosis b) diabetes mellitus c) acute increase in osmolality (hyperglycemia, mannitol infusion) d) cell-­‐tissue breakdown (rhabdomyolysis, tumor-­‐lysis, post-­‐transfusion) e) drugs (succinylcholine, beta-­‐
blockers, digoxin) f) hyperkalemic periodic paralysis (rare disorder of muscular sodium channel) EKG changes * *Peaked T waves, Widening QRS, Loss of P wave, ST depression “sine wave”, v-­‐fib, asystole 1) Administer Calcium Gluconate 10%: administer 0.5-­‐1 mL/kg IV (or 100-­‐200 mg/kg) over 5-­‐10 min. If unavailable, may give Calcium Chloride 10% 0.1-­‐0.2 mL/kg (or 10-­‐20 mg/kg) IV. *contraindicated in hypercalcemic states, digoxin toxicity and tumor lysis syndrome 2) Give regular insulin 0.2 units/kg PLUS D10 10 ml/kg (1g/kg) IV over 30 minutes. May also give 20 ml/kg of D5LR (in the PIXIS). 3) May additionally give: a. Kayexalate 0.5-­‐1 g/kg PO/PR b. Lasix 1-­‐2 mg/kg IV (if producing urine); provide appropriate fluids c. Albuterol 2.5-­‐5 mg nebulized d. Consider NaHCo3 if acidotic (1-­‐2 mmol/kg over 30-­‐60 min) * If giving NaHCO3 and Ca++, remember to flush line between the two as they are not compatible 1) Recheck K+ in 2 hours 2) Admit to ICU Consider dialysis if refractory to treatment Lenhardt A and Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 22 December 2010.