>> Update: For a new take on kayexalate, see Mak Moayedi's Lecture

Hey folks. As I get ready for ACEP, I just wanted to get a quick podcast put up. One of the listeners requested an episode on the treatment of hyperkalemia in the ED.

There was a fantastic article published in Critical Care Medicine on the topic by a Dr. Weisberg. I go through my management and discuss some of the pearls from the article.

Weisberg LS. Management of severe hyperkalemia. Crit Care Med. 2008 Dec;36(12):3246-51.

Additional References added Feb 2012

ECG is insensitive and non-specific for severe hyperkalemia issues; essentially is crap (Clin J Am Soc Nephrol 3: 324-330, 2008). ECG peaked T waves, that resolved after K normalized were noted in only 1 of the 14 hyperkalemic patients who went on to have arrhythmia or cardiac arrest. Only half of them had any T-wave changes.

Calcium Gluconate doesn't require Hepatic Metabolization before it is active

[cite source='pubmed']2360741[/cite]

Hyperkalemia and the ECG

Slow A-Fib

from Steve Smith's Blog

Learning Points:

1.  When a patient is bradycardic, especially if irregular, one must always think of hyperK and one must get a 12-lead ECG.

2. One must recognize this pattern as hyperK

3. Calcium's effect is almost miraculous

4. Slow atrial fibrillation implies an sick AV node, or one affected by electrolytes, ischemia, or medications/drugs.  Otherwise, the ventricular response should be fast.

Furosemide Dosing

Lasix Naive: 1 mg/kg

Prior Use: 1.5 mg/kg

Updates

* Fantastic EMPharm Review with my bud, Bryan Hayes

* Lactated Ringers is Safe and Probably Recommended

* This recent article showed a 100% preceding of bad events by altered ecg

* RCT of 7-day course of kayex1

* Risk of Hospitalization for Serious Adverse Gastrointestinal Events Associated With Sodium Polystyrene Sulfonate Use in Patients of Advanced Age. JAMA Intern Med. 2019 Jun 10. doi: 10.1001/jamainternmed.2019.0631.

and now to the podcast...

1.

Lepage L, Dufour A, Doiron J, et al. Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD. Clin J Am Soc Nephrol. 2015;10(12):2136-2142. [PubMed]