A 54-year-old female with diabetes, hypertension, end-stage renal disease on dialysis presents to the ED after “Snowmageddon” with a complaint of generalized weakness. She answers questions, but seems slightly confused. While awaiting for the initial vital signs, you feel her pulse and find that it is approximately 45. You place an IV while your colleague is putting the patient on the monitor. The PCA then hands you this EKG:
Your first response is:
a)Â ask to see an old EKG
b) soil yourself
c) call the renal fellow to arrange for dialysis
d) administer 1 gram of calcium gluconate IV push
answer1) stabilize the cardiac cell membranes
2) shift potassium into cells
3) excrete potassium from the body
Below is a chart demonstrating the onset and duration of the medications used for the above strategy. Just don’t give sodium polystyrene. It causes more harm than benefit and takes too long to work.
Ultimately, the best way for our above patient to excrete potassium is by hemodialysis- AFTER THEY HAVE BEEN STABILIZED!
Rosen’s Emergency Medicine, 7th Edition.
By: Andy Grock and Sally Bogoch
sbogoch
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1 Comment
Ian deSouza · February 3, 2015 at 11:29 am
Some additional, recent references regarding the treatment of hyperK:
Mahoney BA, Smith WAD, Lo D, Tsoi K, Tonelli M, Clase C. Emergency interventions for hyperkalaemia. Cochrane
Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003235. DOI: 10.1002/14651858.CD003235.pub2.
Kovesdy, C. P. Nat. Rev. Nephrol. 10, 653–662 (2014); published online 16 September 2014; doi:10.1038/nrneph.2014.168