Be wary of hyperkalemia in patients with renal failure

In people with end-stage renal failure, there are often many risks because the kidneys have completely lost their function and one of the dangerous complications is the complication of hyperkalemia.

Potassium is an extremely important electrolyte of the body with an indispensable role in neuromuscular activities. Excess potassium is always a potential threat to the patient's life because hyperkalemia often causes dangerous arrhythmias.
Total body potassium (including intracellular, interstitial and blood) is about 50 mEq/kg body weight with 98% of potassium in cells. Normal blood potassium levels are 3.5-5. mEq/L. When the blood potassium is >5 mEq/L, it is called hyperkalemia, and when the potassium level increases >6.5 mEq/L, it can cause dangerous arrhythmias for the patient. Depending on the amount of potassium inside and outside the cells and the amount of potassium lost through the kidneys, through sweat, and through feces.A normal diet is also relatively adequate for replenishing the daily potassium loss. This is mainly through food, partly through the breakdown of cells in the body (such as red blood cells) and sometimes through the infusion of drugs and fluids that contain a lot of potassium, leading to an increase in potassium. blood.

The kidney is the main organ responsible for potassium regulation. It can be said that when the kidney function is still good, the amount of potassium in the blood never exceeds the threshold of increase. Therefore, when the kidneys fail, especially those with complete failure requiring dialysis or peritoneal dialysis, the amount of potassium always tends to increase in the blood.
Symptoms of hyperkalemia are generally poor, patients only feel weakness, muscle paralysis, pain in the calves, biceps, paresthesias, cramps, nausea, vomiting. Cardiovascular symptoms are always present and are extremely dangerous complications. Patients will have a feeling of palpitations, aborted heart rate (extrasystole), more severe will have a drop in blood pressure, cardiac arrest and the patient will die quickly if not treated promptly.

3.1. General Principle Ensure 3-step CAB in general emergency. Monitor ECG, blood pressure and SpO2. Test for urea, creatinine and electrolytes, metabolic acidosis.
Discontinue potassium in any form (dietary, oral potassium, intravenous solution, parenteral nutrition). Stop and avoid medications that contain potassium (penicillin K). Discontinue and avoid potassium-sparing drugs (potassium-sparing diuretics, angiotensin-converting enzyme inhibitors), or drugs that cause potassium redistribution (succinylcholine). Treat factors that cause extracellular potassium (acidemia, insulin deficiency, increased osmotic pressure). Monitor serum potassium routinely, retesting every 2 hours in severe cases. 3.2. Specific treatment When a patient with chronic renal failure has symptoms of suspected hyperkalemia, immediately stop all sources of potassium entering the body such as drugs or infusions containing potassium. Then quickly determine if the patient has true hyperkalemia. If there is hyperkalemia, quickly reduce the potassium concentration by measures such as:
Pushing potassium from the blood into the cells (the total amount of potassium in the whole body is about 3,500mEq in which, the amount of potassium in the blood is only approximately 20mEq. so the capacity of the cell to store potassium is very large) by rapid insulin infusion with glucose solution (10, 20%); nebulizing beta 2 sympathomimetic drugs such as salbutamol, albuterol; alkalinize the blood with sodium bicarbonate solution...
Use of antagonists both reduce or lose the arrhythmogenic effect of potassium by calcium injection or infusion.

All of these measures only reduce blood potassium but do not reduce potassium actually, so when the drugs wear off, the blood potassium level rises again. So, in the end, removing excess potassium from the body is still of primary importance. Measures include increasing urinary potassium excretion with potent diuretics, peritoneal dialysis, or hemodialysis (cyclic or continuous dialysis) to remove potassium. In some cases, ion exchange resins can be used to eliminate intestinal potassium by giving the patient sodium polystyrene sulfonate resin at a dose of 25-50 g combined with sorbitol to induce diarrhea to pull potassium out of the body. body.
In patients with chronic renal failure, always have to be alert to hyperkalemia, so it is necessary to pay attention to some preventive measures such as: Do not drink, administer drugs or solutions containing potassium, daily diet also must avoid foods that contain a lot of potassium such as bananas, papayas, and milk that are high in potassium. And keep an eye out for signs of hyperkalemia and have regular tests to keep an eye on it. Follow a strict schedule of dialysis or dialysis to remove excess potassium.
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