Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

750 Hyperkalemia Hypermagnesemia

follow-up

■frequent monitoring of K is required to ensure that hyperkalemia has

been successfully treated

■avoid foods high in K

■avoid medications that impair renal K excretion

complications and prognosis

■complications of hyperkalemia are cardiac and muscular

➣musculoskeletal: severe weakness

➣cardiac: peaked T waves, increased P-R interval, QRS widening,

Sine wave and ventricular fibrillation

■during treatment avoid development of hypokalemia

■use of insulin can be associated with hypoglycemia

■administration of glucose without insulin in type I diabetes can lead

to worsening of hyperkalemia

■NaHCO3 tablets can lead to volume overload in renal failure patients

■sodium polystyrene sulfonate with sorbitol can lead to intestinal

necrosis in post-surgical patients

■use 0-K bath in hemodialysis for no >1 hour to avoid precipitating

arrhythmias

■hyperkalemia is readily treatable, ultimate prognosis dependent

upon underlying cause

Hypermagnesemia...................................

STANLEY GOLDFARB, MD

history & physical

History

■Usually is iatrogenic and occurs in patients who have impaired renal

function and ingest magnesium as either laxatives or antacids.

■Acute magnesium intoxication may occur in women who are treated

for toxemia of pregnancy with intravenous magnesium salts that are

administered at an excessive rate. Muscular paralysis can develop at

serum magnesium levels of 10 mg/dl.

Signs & Symptoms

■Magnesium level>4mEqperliter.

➣Inhibition of neuromuscular transmission

➣Deep tendon reflexes are abolished