Hyperkalemia- how to manage?
Hello, my 69-year-old female friend was found in her apartment, lying on the floor barely responsive. Systematic initial evaluation by the arriving ambulance crew revealed the following: (a) airway not obstructed. (b) cyanotic, breathing rate 20/min, peripheral oxygen saturation not measurable, and vesicular breathing sounds bilaterally. (c) pale, hypotensive at 40/20mm Hg, the ECG showing a bradycardic rhythm with a left bundle branch block at a heart rate of 22 bpm. No injury marks, no edema, and no signs of venous congestion was found. She has been diagnosed with hyperkalemia. Please advise how to manage.
@satwika Hyperkalemia is defined as a serum potassium concentration exceeding 5.0 mEq/L. The incidence in hospitalized patients ranges from 1% to 10%, and mortality amounts up to 1 per 1000. The main underlying mechanisms can be summed up as: (a) impaired renal excretion system (caused by reduced glomerular filtration rate/reabsorption in the proximal tubule/secretion in the distal convoluted tubule and collecting duct), (b) impaired or pharmaceutically inhibited renin-angiotensin system (RAS), triggered by effects of hormones such as aldosterone or vasopressin, (c) reduced cardiac output (due to impaired renal perfusion), (d) insulin deficiency (caused by impaired transportation of potassium from extra- to intracellular spaces), and (e) acidosis (through increased shift of potassium to the extracellular space on an ubiquitous cellular level and by decreased secretion and increased reabsorption in the collecting duct). Further reasons of hyperkalemia can include extensive tissue breakdown such as in rhabdomyolysis, burns, or trauma