Hyperkalemiaaditsmanagement 141202233459 Conversion Gate01 (1)

8/19/2019 Hyperkalemiaaditsmanagement 141202233459 Conversion Gate01 (1)

1/35


2/35

HYPERKALEMIA AND

ITS MANAGEMENTPrepared by:

Dr. Muhammad Asim Fazal

MEEQAT GENERAL HOP!TAL

ALMAD!NAH ALM"NA#ARAH


3/35

De$%i&i'% (rie) re*ie+ ') p'&assium re,ula&i'%

pr'-esses auses li%i-al Ma%i)es&a&i'%s Therapy

Objectives


4/35

Hyper/alemia 0 plasma 12 -'%-e%&ra&i'% 34.5mm'l6L

ri&i-al hyper/alemia 0 plama 12-'%-e%&ra&i'% 3 7.4 mm'l6L

Defnition


5/35

8The %'rmal serum le*el ') p'&assium is 9.4 &' 4

mm'l6L

8Daily Reuireme%&s 585.4 mm'l6/,

8Die&ary s'ur-es i%-lude dried )rui&s; le,umes; mea&s;p'ul&ry; $sh; s'y; ba%a%as; -i&rus )rui&s; p'&a&'es;&'ma&'es; br'--'li; mushr''ms; dar/< lea)y ,ree%

*e,e&ables


6/35

!%&ra-ellular -'%-e%&ra&i'% ab'u& 54=mm'l6L The passi*e 'u&+ard di>usi'% ') 12 is &he

m's& imp'r&a%& )a-&'r &ha& ,e%era&es &he

res&i%, membra%e p'&e%&ial. Mai%&e%a%-e ') s&eady s&a&e reuires 12

i%,es&i'% 0 12 e?-re&i'% Nearly all re,ula&i'% ') re%al 12 e?-re&i'%

a%d &'&al b'dy 12 bala%-e '--urs i% &hedis&al %ephr'%< *ia pri%-ipal -ells

P'&assium se-re&i'% re,ula&ed byald's&er'%e a%d plasma 12 -'%-e%&ra&i'%

Potassium Reu!ation Revie"


7/35

Potassium#omeostasis

This e?-ess is@5=B e?-re&ed &hr'u,h &he ,u&@C=B e?-re&ed &hr'u,h &he /id%eys

8 The m's& imp'r&a%& si&e ') re,ula&i'% is &hedis&al %ephr'%< i%-ludi%, &he dis&al -'%*'lu&ed&ubule< &he -'%%e-&i%, &ubule< a%d &he -'r&i-al-'lle-&i%, &ubule

8Gas&r'i%&es&i%al abs'rp&i'% is -'mple&e< resul&i%, i%daily e?-ess i%&a/e ') ab'u& 5 mm'l6/,6d


8/35

!. P'&assium release )r'm -ells

!!. E?-essi*e !%&a/e

!!!. De-reased re%al l'ss

!. !a&r',e%i-

@'%sider pseud'hyper/alemiaB

$auses o% H&'e()a!emia


9/35

!%&ra*as-ular hem'lysis Tum'r Lysis y%dr'me Rhabd'my'lysis

Me&ab'li- a-id'sis Hyper,ly-emia e*ere Di,i&alis &'?i-i&y Hyper/alemi- peri'di- paralysis

(e&a8bl'-/ers u--i%yl-h'li%e; espe-ially i% -ase massi*e

&rauma< bur%s 'r %eur'mus-ular disease

Potassium (e!ease %(om ce!!s


10/35

8 "%-'mm'% -ause ') hyper/alemia.

8The me-ha%isms )'r shi)&i%, p'&assium i%&ra-ellularly

a%d )'r re%al e?-re&i'% all'+ a pers'% +i&h %'rmalp'&assium h'me's&a&i- me-ha%isms &' i%,es&*ir&ually u%limi&ed ua%&i&ies ') p'&assium i% heal&hyi%di*iduals.

8M's& ')&e%< i& is -aused i% a pa&ie%& +i&h impairedme-ha%isms )'r &he i%&ra-ellular shi)& ') p'&assium 'r

)'r re%al p'&assium e?-re&i'%

E*cessive inta)e


11/35

-

!s &he m's& -'mm'% -ause

- 8The -auses ') de-reased re%al p'&assiume?-re&i'% i%-lude:

- re%al )ailure

diabe&es melli&us

si-/le -ell disease

Dec(ease+ e*c(etion

Medi-a&i'%s @e,< p'&assium8spari%, diure&i-s<NA!D


12/35

ausesS#i%t %(om ,I$-to E$-.

Dec(ease+ (ena! e*c(etion E*cessive inta)e

Hyper'sm'lali&y

rhabd'my'lysis

&um'r lysis

u--i%yl-h'li%

i%suli% de$-ie%-y a-u&e a-id'sis.

Diabe&es melli&us @esp diabe&i-%ephr'pa&hy

Re%al )ailure

'%,es&i*e hear& )ailure

LE

i-/le -ell a%emia

NA!D

AE !%hibi&'r

P'&assium spari%, Diure&i-s

Mul&iple Myel'ma

-hr'%i- par&ial uri%ary &ra-&

Oral 'r !P'&assiumuppleme%&a&i'%

al& subs&i&u&e

(l''d&ra%s)usi'%


13/35

Pseu+o#&'e()a!emia

8!& is &he &erm applied &' &he -li%i-al si&ua&i'% i%+hi-h i% *i&r' lysis ') -ellular -'%&e%&s leads &' &hemeasureme%& ') a hi,h serum p'&assium le*el %'&

ree-&i*e ') &he &rue i% *i*' le*el.

8'%di&i'% '--urs m's& -'mm'%ly +i&h

red -ell hem'lysis duri%, &he bl''d dra+@&'ur%iue& &'' &i,h& 'r &he bl''d le)& si&&i%, &''l'%,B<


14/35

#ea/%ess< +hi-h -a% pr',ress &' a--id paralysis a%dhyp'*e%&ila&i'%.e-'%dary &' pr'l'%,ed par&ial dep'lariza&i'% )r'm &he ele*a&ed 12 <+hi-h impairs membra%e e?-i&abili&y.

Me&ab'li- a-id'sis< +hi-h )ur&her i%-reases 12e-'%dary &' hyper/alemia impairi%, re%al amm'%ia,e%esis a%d

abs'rp&i'%< a%d &hus %e& a-id e?-re&i'%.Al&ered ele-&ri-al a-&i*i&y ') hear&< -ardia- arrhy&hmias.

EG -ha%,es i% 'rder ') appeara%-e:

Tall< %arr'+8based< pea/ed T +a*es

Pr'l'%,ed PR i%&er*al a%d QR dura&i'%

A -'%du-&i'% delayL'ss ') P +a*es

Pr',ressi'% ') QR dura&i'% leadi%, &' si%e +a*e pa&&er%

e%&ri-ular $brilla&i'% 'r asys&'le

$!inica! Mani%estations


15/35

#ea/%ess a%d )a&i,ue@m's& -'mm'%B )Fa%/ mus-le paralysis

h'r&%ess ') brea&h

Palpi&a&i'%s

S&m'toms


16/35

8i&al si,%s ,e%erally are %'rmal

E?-ep&brady-ardia due &' hear& bl'-/

'r &a-hyp%ea due &' respira&'ry mus-le+ea/%ess.

Physical


17/35

Lab

Assess re%al )u%-&i'%.

he-/ serum ("N a%d -rea&i%i%e le*els &'de&ermi%e +he&her re%al i%su-ie%-y isprese%&

he-/ I8h'ur uri%e )'r -rea&i%i%e-leara%-e

Es&ima&e &he ,l'merular $l&ra&i'% ra&e @GFRB


18/35

EG

ha%,es '--ur +he% erum P'&assium 37.=mm'l 6L

A8!%i&ial T #a*es pea/ed 'r Te%&ed

(8Ne?&T depressi'%l'ss ') P #a*e

QR +ide%i%,

8Fi%al(iphasi- +a*e @si%e +a*eB QR a%d T )usi'%

http://www.fpnotebook.com/CV/Exam/TWv.htmhttp://www.fpnotebook.com/CV/Exam/PWv.htmhttp://www.fpnotebook.com/CV/Exam/PWv.htmhttp://www.fpnotebook.com/CV/Exam/TWv.htm


19/35


20/35


21/35


22/35

Measu(e com'!ete

metabo!ic '(of!e

8L'+ bi-arb'%a&e may su,,es& hyper/alemia

due &' me&ab'li- a-id'sis.

8Hyper,ly-emia su,,es&s diabe&es melli&us.


23/35

T(eatment

The $rs& s&ep

8de&ermi%e li)e8&hrea&e%i%, &'?i-i&y.(y Per)'rm a% EG &' l''/ )'r -ardi'&'?i-i&y.

8 i) prese%&Admi%is&er !* al-ium Glu-'%a&e &' ameli'ra&e-ardia- &'?i-i&y.

8!%i&ial d'se: 5= ml '*er 84 mi%u&es

e-'%d d'se a)&er 4 mi%u&es i) %' resp'%se

8E>e-& '--urs i% mi%u&es a%d las&s )'r 9=87=mi%u&es

A%&i-ipa&e E1G impr'*eme%& +i&hi% 9 mi%u&es


24/35

The se-'%d s&ep

8!s &' ide%&i)y a%d rem'*e s'ur-es ') p'&assiumi%&a/e

8ha%,e &he die& &' a l'+8p'&assium die&.


25/35

8Measure ,lu-'se a%d p'&assium e*ery h'urs

8'rre-& me&ab'li- a-id'sis +i&h s'diumbi-arb'%a&e. 4=ml !6 b'lus

8e%&'li% Nebuliza&i'%

The &hird s&ep

8P'&assium shi)& )r'm i%&ra*as-ular &'

i%&ra-ellular8Glu-'se a%d !%suli% !%)usi'% !%suli% Re,ular 5= u%i&s !4= ml 4= ') de?&r'se

http://www.fpnotebook.com/Endo/Pharm/VrblRtInslnInfsn.htmhttp://www.fpnotebook.com/Endo/Pharm/Insln.htmhttp://www.fpnotebook.com/Endo/Pharm/Insln.htmhttp://www.fpnotebook.com/Endo/Pharm/VrblRtInslnInfsn.htm


26/35

The )'ur&h s&ep

8!s &' i%-rease p'&assium e?-re&i'% )r'm &he b'dy

8i% %'rmal /id%ey )u%-&i'% by &he admi%is&ra&i'% ')pare%&eral sali%e a--'mpa%ied by a l''p diure&i-<

su-h as )ur'semide D'se: =8I= m, !.


27/35

8Dis-'%&i%ue p'&assium8spari%, diure&i-s<a%,i'&e%si%8-'%*er&i%, e%zyme i%hibi&'rs<a%,i'&e%si% re-ep&'r bl'-/ers< a%d '&her dru,s &ha&

i%hibi& re%al p'&assiume?-re&i'%.

M'%i&'r *'lume s&a&us a%d aim &' mai%&ai%eu*'lemia.

8!% pa&ie%&s +i&h hyp're%i%emia 'r hyp'ald's&er'%ismRe%al e?-re&i'% -a% be e%ha%-ed by admi%is&ra&i'% ')a% ald's&er'%e a%al',ue< su-h as C8alpha

u'r'hydr'-'r&is'%e a-e&a&e @Fl'ri%e)B.


28/35

Emer,e%-y dialysis

!s a $%al re-'urse )'ru%resp'%si*e hyper/alemia +i&h

re%al )ailure.


29/35

A 48year8'ld ma% +i&h hyper&e%si'% a%d diabe&es-'mplai%s ') +ea/%ess< %ausea< a%d a ,e%eral se%se ')ill%ess< &ha& has pr',ressed sl'+ly '*er 9 days. Hismedi-a&i'%s i%-lude a sul'%ylurea< a diure&i-< a%d a% AEi%hibi&'r. O% e?ami%a&i'%< he appears le&har,i- a%d ill. His

(P is 54I65=4 mm H,< HR J=bpm< &empera&ure CK.7 F< a%drespira&'ry ra&e brea&hs6mi%. The physi-al e?ami%a&i'%re*eals m'dera&e u,ular *e%'us dis&e%si'%< s'me mi%'rbibasilar rales< a%d l'+er e?&remi&y edema. He is 'rie%&ed&' pers'% a%d pla-e bu& is able &' ,i*e )ur&her his&'ry. The

EG sh'+s a +ide -'mple? rhy&hm.

Lab'ra&'ry s&udies per)'rmed are si,%i$-a%& )'r p'&assiumJ.K mE6L< ("N is 55I m,6dL a%d -rea&i%i%e is 5=.4.

$!inica! Scena(io


30/35

Dianostics/Imaes0 E$G


31/35

Easily Dis&i%,uished EG si,%s:◦ pea/ed T +a*e.

◦ pr'l'%,a&i'% ') &he PR i%&er*al

◦ T -ha%,es @+hi-h may mimi- my'-ardial

i%)ar-&i'%B◦ *ery +ide QR< +hi-h may pr',ress &' a si%e

+a*e pa&&er% a%d asys&'le.

Pa&ie%&s may ha*e se*ere hyper/alemia +i&hmi%imal EG -ha%,es< a%d pr'mi%e%& EG-ha%,es +i&h mild hyper/alemia.

E$G $#anes o% H&'e()a!emia


32/35

Dia,%'sis: H&'e()a!emia1 Seve(e

◦ $!assifcation o% H&'e()a!emia NORMAL: 9.4 &' 4.= mE6L.

M!LD: 4.4 &' 7.= mE6L EERE: Le*els ') J.= mE6L 'r ,rea&er

!& is imp'r&a%& &' sus'ect t#is con+ition )r'm

&he #isto(& a%d E$G< be-ause lab'ra&'ry test(esu!ts may be +e!a&e+ a%d &he pa&ie%& -'ulddie be)'re &h'se &es& resul&s be-'me a*ailable.

Ana!&sis


33/35

1st Line option


34/35

ymp&'ms ') hyper/alemia are usually%'%spe-i$-< s' ris/)a-&'rs mus& be used &' suspe-& &he dia,%'sis

EG -ha%,es -'%sis&e%& +i&h hyper/alemia sh'uldbe &rea&ed immedia&ely as a li)e8&hrea&e%i%,emer,e%-y. D' %'& a+ai& lab'ra&'ry -'%$rma&i'%.

!%&ra*e%'us -al-ium is &he a%&id'&e ') -h'i-e )'r li)e8&hrea&e%i%, arrhy&hmias rela&ed &' hyper/alemia<bu& i&s e>e-& is brie) a%d addi&i'%al a,e%&s mus& beused

$!inica! Pea(!s


35/35

THANKYO2

Hyperkalemiaaditsmanagement 141202233459 Conversion Gate01 (1)

Documents