Workup-hyperkalemia

(Crit Care Med 2008;36:3246)

• Rule out pseudohyperkalemia (IVF w/ K, tourniquet, hemolysis, ↑ plt or WBC), rule out transcellular shift

• Assess GFR, if normal, then ✓UK, UNa (<25 mEq/d ↓ distal Na delivery). ✓ UK:Cr (<13 favors ↓ renal K excretion).

• Rate of onset important to note when establishing a treatment plan (Mayo Clinic 2020;96:744)

• Stabilize (initial): 10% CaCl (central) or gluconate (IV). ↑ memb. potential → ↓ excitability

• Redistribute: insulin + dextrose (continuous if NPO), HCO3, β2-agonists

• Eliminate: SPS, patiromer, Na zirconium, diuretics (w/ saline if preserved renal fxn), consider emergent HD in life-threatening situations

• Patient information for diet education: http://www.kidney.org/atoz/content/potassium