Signs, causes and treatment of hyperkalemia

The article was written by Doctor Nguyen Ngoc Phuong Nam - Emergency Medicine Doctor - Emergency Department - Vinmec Central Park International General Hospital.

Hyperkalemia is the medical term that describes a higher than normal level of potassium in your blood. Potassium is a chemical that is very important for the function of nerve and muscle cells, including the heart muscle. Your blood potassium level is usually between 3.6 and 5.2 millimoles per liter (mmol/L). A blood potassium level higher than 6.0 mmol/L can be dangerous and usually requires immediate treatment.

Mild to moderate hyperkalemia is usually asymptomatic. Symptoms usually manifest when the serum potassium is above 7.0 mmol/L: Progressive muscle weakness and paralysis starting in the legs and progressing to the trunk and arms. In addition, the symptoms before muscle weakness are often vague, such as numbness in the tips of the fingers and toes, decreased sensation. Cardiovascular: Heart palpitations, palpitations, possibly fainting, circulatory arrest. Hyperkalemia can cause rhabdomyolysis or gastrointestinal bleeding, or be in the clinical setting: soft tissue trauma, burns, tumor lysis, polycythemia, acute renal failure or chronic renal failure.. .

Acute renal failure or chronic renal failure. Diabetes caused by insulin deficiency Cardiovascular disease: Being treated with cardiovascular drugs, diuretics Acute dehydration: Excessive exercise, dehydration due to hyperthermia. Severe muscle breakdown or hemolysis Mass blood transfusion, exchange transfusion.

First priority :
Do ECG immediately to assess the danger of hyperkalemia. Some ECG wave changes require immediate empirical treatment. Repeat blood potassium testing to confirm hyperkalemia if it is inconsistent with clinical findings. Second priority:
Perform more tests to check kidney failure including blood urea, creatinine, electrolytes (sodium, bicarbonate, calcium, chlorine), pH, blood sugar, CK. As well as consider doing more electrolytes, urinalysis to diagnose renal failure. Renal Doppler ultrasound to assess renal perfusion is normal. Next priorities:
Monitor hemodynamic status, monitor blood potassium levels, monitor urine output.

Drug treatment:
In case of ECG changes and/or cardiac arrhythmias Calcium injection: Antagonists the effect of increased potassium by stabilizing cell membranes, preventing dangerous arrhythmias. Calcium gluconate or Calcium chloride can be used, but Calcium gluconate is safer. The duration of action of calcium therapy is usually short and does not address the root problem of the hyperkalemia. Glucose and insulin infusion, nebulization of beta-2 adrenergic blocking drugs, sodium bicarbonate infusion will increase potassium transport into cells. These treatments also do not completely solve the problem of increased potassium but temporarily until the potassium is eliminated from the body. Diuretics and dialysis (in case of anuria renal failure) will remove potassium from the body. Using ion exchange resins (Sodium polystyrene sulfonate) The essence of the drug is sodium-binding resin particles, which, when entering the intestinal mucosa, especially in the colon, will release sodium ions and irreversibly bind to potassium and excreted in the feces as potassium polystyrene sulfonate. The effectiveness of this method is difficult to predict. Identify the cause and treat the cause of hyperkalemia. Discontinue potassium supplements or medications that cause hyperkalemia. Management after stabilization:
Monitor treatment:
Retest potassium levels every 4-6 hours until stable and/or underlying causes and conditions are resolved. Persistent hyperkalemia despite diuretic therapy may suggest tissue necrosis elsewhere. For patients with risk factors for hyperkalemia, it is advisable to periodically check blood potassium for timely correction. If you need to consult and visit the hospitals and clinics of Vinmec Health system nationwide, please contact the Website for the best service.