Internal Medicine

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

Hyperkalemia 749

heparin

azol-antifungal agents (ketoconozol)

distal tubular defect (increased renin, increased aldosterone)

tubulointerstitial renal disease

drug

spironolacton

triamterene

amiloride

high dose trimethoprim, intravenous pentamidine

management

■obtain EKG to exclude pseudohyperkalemia and to detect presence

of EKG changes that require urgent treatment

■renal failure is responsible in setting of acute oligo-anuric renal fail-

ure or end stage renal failure with GFR <10 ml/min

■with mild to moderate renal failure (GFR >10 ml/min)

➣look for evidence of tubulointerstitial renal disease: sterile pyuria,

WBC casts, low grade proteinuria, eosinophiluria

➣determine if drugs that impair renal K excretion are present

➣if diabetic, consider hyporeninemic hypoaldosteronism

➣measure renin and aldosterone if indicated

specific therapy

■level of serum K and presence or absence of EKG changes determine

therapy

■hyperkalemia in setting of diabetic ketoacidosis responds to insulin

and fluids (with therapy anticipate development of hypokalemia)

■Acute treatment: EKG changes or symptoms of muscle weakness

➣Reverse effects on heart

calcium

➣Shift K into cells

glucose and insulin NaHCO3

beta2- adrenergic agonist: albuterol inhaler

➣Remove K from body

hemodialysis

cation exchange resin: sodium polystyrene sulfonate

■Chronic treatment: asymptomatic hyperkalemia without EKG

changes

➣low K diet

➣loop diuretics

➣NaHCO3 tablets

➣fludrocortisone if patient not hypertensive