# Hyperkalemia --- **Hyperkalemia** is a condition where the concentration of [[potassium]] in the blood is too high. Potassium is found in high levels inside our cells, but rather low levels in the serum. Because potassium is critical in the [[heart]] where it powers the contractions, too high of a potassium concentration can lead to abnormal heart rhythm (tall, peaked T-waves) and even [[myocardial infarction|heart attack]] and [[death]]. ## Causes The [[kidneys]] are generally good at filtering out higher than normal potassium levels, so hyperkalemia rarely occurs with normal renal function. However, when the kidneys excrete sodium they retain potassium, so we commonly see hyperkalemia as a consequence of decreased sodium retention. - decreased kidney function - [[older adult|older adults]] - [[renin-angiotensin-aldosterone system|hypoaldosteronism]] - Na+ excreted and thus K+ *retained* - [[acidosis]] - Increased serum H+ causes a flow of H+ into the cells -> also positively charged K+ gets booted out of the cells - tissue damage ([[burns]], crush injury, [[rhabdomyolysis]], etc) - intracellular K+ is released into the bloodstream - meds - rapid/over-administration of K+ - [[ACE inhibitors]] - decreases [[renin-angiotensin-aldosterone system|aldosterone]] (see above) - too much [[diuretics|potassium sparing diuretics]] ## Signs & Symptoms The signs and symptoms of hyperkalemia are related to muscular and cardiac functions. - muscle weakness, numbness - shallow respirations - hypoactive bowel sounds - low CO - decreased deep tendon reflexes - cardiac changes - ECG changes - Tall, peaked T-waves - Wide, flat P waves - Prolonged PR interval - widened QRS complex - depressed ST segments - vtac, vfib - bradycardia - asystole ![[hyperkalemia ECG.png]] ## Treatment Treatment for hyperkalemia consists of either getting potassium into the cells or out of the body. - Potassium into the cells - D5W and regular [[insulin]] - when insulin enters the cell, it takes potassium along with it - albuterol - bicarbonate - Potassium out of the body - sodium polystyrene sulfate, or "Kayexalate" - it creates pretty spectacular diarrhea - the ED's gift the the ICU - [[diuretics]] - loop or thiazides - dialysis - this is a last resort if it's severe and they're not responding Sometimes calcium gluconate or chloride is given to protect the heart muscle. ## Nursing Considerations - Priority = ECG (12 lead) - CMP/ABGs - restrict meds/foods - potatoes, oranges, milk, salmon, dried beans, avocados ___