Location of hyperkalemia

Article written by Specialist Doctor II Nguyen Thi Minh Tam - Vinmec Royal City International Clinic

Currently, hyperkalemia is a common disease and has a high mortality rate when not treated promptly. Understanding the disease will help patients prepare well in terms of health as well as minimize unnecessary risks.

Potassium is present mainly in the cells, then is excreted in the urine. For some reason, or due to a specific medical condition, leading to increased potassium in the blood, or potassium not being excreted normally in the urine, the blood potassium will increase.
Hyperkalemia is a common electrolyte disorder in the Emergency and ICU. Can be fatal if not treated promptly. Cardiac arrest is sometimes the first sign of hyperkalemia, so doctors need to pay attention and understand the need for emergency treatment. Some blood potassium indicators to know include:
Normal blood potassium: 3.5 - 5 mmol/L. Hyperkalemia when ≥ 5.5 mmol/L (According to European Resuscitation Council Guideline). Mild hyperkalemia: 5.5-5.9 mmol/L. Moderate hyperkalemia: 6.0-6.4 mmol/L. Severe hyperkalemia: ≥6.5 mmol/L. Severity of hyperkalemia: also based on electrocardiographic abnormalities.

Causes of hyperkalemia are related to a number of diseases and the use of certain medications, including:
Kidney disease Adrenal insufficiency (mineralocorticoids) Transport from the inside to the outside: Acidosis (acidosis) ketosis, lactic acidosis...) Increased potassium production (often accompanied by renal failure): severe trauma, rhabdomyolysis, hemolysis, tumor lysis syndrome, burns. Bring in from outside: use potassium-containing drugs, large blood transfusions. Drugs eg: NSAIDs, Trimethoprim, Heparin, Chemotherapy, K -sparing diuretic, ACE inhibitor, Beta-blockers, Succinylcholine, Digoxin, Mannitol.

Electrocardiographic changes may appear early when serum potassium > 5.5 mmol.l. However, there is no strong correlation between the degree of hyperkalemia and changes in the electrocardiogram and it depends on the individual patient. When serum potassium rises slowly, there are less electrocardiographic changes than in acute hyperkalemia and are associated with hyponatremia, hypocalcemia, and acidosis.
Tall T waves (in early stage). PR prolonged, P flattened, QRS dilated (risk of arrhythmia). Loss of P wave, sine wave (QRS and T intermingled). Ventricular arrhythmia, asystole. The severity of the electrocardiogram usually increases with serum potassium levels.
But it should be noted that each serum potassium level in each patient does not necessarily have the same degree of EKG.

4.1. Cardioprotective membrane stabilizing drugs: Calcium chloride or calcium gluconate. Indicated when hyperkalemia is accompanied by electrocardiographic manifestations. No hypokalemic effect. Dosage: 10 mmol Ca++ (1 g CaCl), slow intravenous injection for 5 - 10 minutes Acts after 3 - 5 minutes, lasts 30 - 60 minutes. The injection can be repeated after 5 minutes if there is no effect. Caution in patients taking digoxin: slow intravenous injection (30 minutes)
Contraindications: digoxin poisoning.
4.2. Transport of potassium into cells Insulin phase glucose intravenous infusion
Indicated in severe hyperkalemia (K+ ≥ 6.5 mmol/L). May also be indicated in moderate hyperkalemia (K + = 6.0 - 6.4 mmol/L). Mix 10 units of insulin in a glucose solution (25 g glucose: 125 mL 20% sugar) IV over 15-30 minutes. Effects after 15 minutes, peak after 60 minutes, lasting for 2-3 hours. Pay attention to the risk of hypoglycemia → TD blood sugar. Nebulized salbutamol
Indicated for severe hyperkalemia (K+ ≥ 6.5 mmol/L. Also indicated for moderate hyperkalemia (K+ = 6.0 - 6.4 mmol/L). dose 10 - 20 mg salbutamol Starts effect after 30 minutes, lasts 2 - 3 hours Do not use salbutamol as monotherapy in the treatment of severe hyperkalemia With caution in patients with heart disease (because the drug causes an increase in heart rate). Alkaline solution
Use only in severe metabolic acidosis causing hyperkalemia Severe hyperkalemia: sodium bicarbonate 8.4% (1 mmol/mL) 1-3 ml IV over 5 minutes Moderate hyperkalemia: Sodium bicarbonate 8, 4% (1 mmol/mL) 1 ml intravenous infusion over 30 minutes Start of action: 30 - 60 minutes, lasts 2 - 3 hours 4.3 Elimination of potassium from the body Loop diuretics use furosemide early, maintain Maintain urine output according to the in and out fluid
Ion exchange resin is indicated in the treatment of moderate and mild hyperkalemia
Kayexalat 15g x 4 times/day, orally or rectally 30g x 2 times/ day.
Starts to work after 1 hour (enemas), up to 6 hours (oral), dozen clearly used within 1-5 days. There may be undesirable effects on the gastrointestinal system, or hypernatremia.
Extrarenal dialysis is the most effective, fastest way to remove potassium and correct other disorders.
4.4. Monitoring treatment UK Renal Association recommendations 2014
Continuous monitoring of the electrocardiogram on the monitor, periodic 12-lead ECG. Blood potassium test: at 1-2-4-6 hours, from the start of treatment. Goal: lower potassium < 6 mmol/L after 2 hours. Capillary blood sugar test: before insulin, 15-30 minutes, then every hour, for 6 hours.

4.5. Treat the cause Treat the cause of the hyperkalemia. Stop drugs and foods that contain potassium, or drugs that cause hyperkalemia. 4.6. Precautions in the treatment of hyperkalemia Caution should be exercised when administering calcium to patients taking digoxin. Salbutamol administration lowers blood potassium, but causes tachycardia. Diabetic coma patient if there is hyperkalemia:
Treatment with insulin and intravenous fluids, blood potassium will decrease with treatment. When calculating potassium-lowering therapy, this should be known. Only give bicarbonate for very severe acidosis (pH < 7.0) Careful monitoring of blood potassium, in the course of some diseases, potassium replacement may be possible according to treatment guidelines to avoid the risk of hypokalemia. Hyperkalemia is very dangerous if the patient subjectively does not go to the doctor and strictly follow the prescribed regimen. Therefore, when you have symptoms of the disease, you should go to the hospital as soon as possible to have timely treatment measures.
With many years of experience in the examination and treatment of diseases, now Vinmec International General Hospital has become one of the major health care centers, capable of examining, screening and treating diseases. treat many serious diseases. Therefore, you can go to Vinmec International General Hospital to visit and receive support and advice from doctors.