Clinical Assessment, Investigation and Treatment of Renal Disease in Africa: A Practical Guide for Primary Care Physicians
Meguid El Nahas in Kidney Diseases in the Developing World and Ethnic Minorities, 2005
Electrolyte disturbances. Hyperkalemia is common and results from reduced renal excretion of potassium, as a side effect of drugs (e.g., ACE inhibitors) and in acidosis. The clinical problems associated with raised serum potassium are cardiac arrhythmias, which include ventricular fibrillation, and asystole. Attempts should be made to lower potassium when serum K+ exceeds 6.0 mmol/L. Give 10 mL of 10% calcium gluconate slowly IV if the ECG is abnormal. The dose can be repeated 30 to 60 minutes later. Alternatively, one can give 50 mL of 50% dextrose with 10 units of soluble human insulin, over 30 minute. This can be repeated if the hyperkalemia persists. Oral polystyrene sulfonate resin (calcium resonium), in a dose of 15 g four times daily, removes potassium from the body. All potassium-retaining drugs should be stopped.
Muscle Disorders
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
More severe cases: Dantrolene 2 mg/kg IV q 5 min, up to 10 mg/kg: inhibits calcium release from the sarcoplasmic reticulum.Treat associated hyperkalemia.Increase ventilation.Correct the acid–base disturbance: give IV sodium bicarbonate 2–4 mg/kg.Cool the patient: cooling blankets and cold IV fluids until temperature reaches 38°C (100°F).Intravenous hydration with or without diuretics if myoglobinuria is present.Give steroids for the acute stress reaction.
Polyendocrine Syndromes
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
In theory, treatment of hyporeninemic hypoaldosteronism can be accomplished by mineralocorticoid replacement in the form of fludrocortisone 0.5-2.0 mg daily. In reality, however, this is not suitable therapy for most diabetic patients with the disorder. By the time patients develop hyporeninemic hypoaldosteronism, they have frequendy had diabetes and associated renal disease long enough that they are likely to have hypertension, edema, or other volume-overload problems, and as a result the use of a sodium-retaining (and thus volume-retaining) agent, such as fludrocortisone, is counterproductive. Instead, preferred options for managing the hyperkalemia include dietary potassium restriction, avoidance of drugs that cause potassium retention, avoidance of severe hyperglycemia, treatment of acidosis with bicarbonate, use of a cation-exchange resin (Kayexalate), and use of a loop diuretic for the volume excess state.
Development of a health economic model to evaluate the potential benefits of optimal serum potassium management in patients with heart failure
Published in Journal of Medical Economics, 2018
Ameet Bakhai, Eirini Palaka, Cecilia Linde, Hayley Bennett, Hans Furuland, Lei Qin, Phil McEwan, Marc Evans
Hyperkalemia may result from excessive potassium intake, pathologies that increase intracellular potassium release, or, most notably, ineffective potassium clearance. Subsequently, renal insufficiency represents a significant predictive risk factor for the development of hyperkalemia, either alone or as a consequence of heart failure5–7. Neurohormonal activation of the renin-angiotensin-aldosterone system (RAAS) is implicated in the pathogenesis of heart failure; chronic activation of this compensatory pathway consequently leads to organ fibrosis, renal dysfunction, and increased susceptibility to hyperkalemia8. Recent evidence suggests that heart failure patients who develop hyperkalemia are generally older and more comorbid than those who do not develop hyperkalemia9. Nevertheless, the incidence of hyperkalemia in heart failure patients has been associated with increased risks of hospitalization and mortality, and, consequently, imposes a significant burden on this population9–13.
Emerging therapeutic strategies for transplantation-induced acute kidney injury: protecting the organelles and the vascular bed
Published in Expert Opinion on Therapeutic Targets, 2019
Nicolas Melis, Raphael Thuillier, Clara Steichen, Sebastien Giraud, Yse Sauvageon, Jacques Kaminski, Thomas Pelé, Lionel Badet, Jean Pierre Richer, Jonatan Barrera-Chimal, Frédéric Jaisser, Michel Tauc, Thierry Hauet
Pharmacological MR antagonism is associated with side effects related to its potassium sparing effect through its action on the distal nephron. This may lead to hyperkalemia, a significant problem in patients with renal dysfunction. However, low doses of MRA, as used in recent clinical trials in CV diseases, are safe and did not lead to life-threatening hyperkaliemia, despite the significant increase in plasma potassium (related to their renal effects). New generation MRA with less potassium-sparing effects would be useful, in particular in patients with renal failure. Clinical trials are required to test the safety of the classical MR antagonists in this particular context as well as novel non-steroidal MRA as Finerenone, which had reduced deleterious effects on kalemia as compared to spironolactone in heart failure with CKD [100]. Moreover, eplerenone was recently demonstrated to be safe in transplanted patients with decreased renal function [101] and is currently in a clinical trial to prevent adverse outcome in kidney transplantation [102].
Inpatient management and post-discharge outcomes of hyperkalemia
Published in Hospital Practice, 2021
Jill Davis, Rubeen Israni, Fan Mu, Erin E. Cook, Harold Szerlip, Gabriel Uwaifo, Vivian Fonseca, Keith A. Betts
Hyperkalemia treatment was more frequent as the severity of the hyperkalemia increased. Temporizing agents were the most common treatment during the inpatient stay (mild: 28.9%; moderate: 46.0%; severe 73.0%) and intravenous calcium was the most common temporizing agent (mild: 16.5%; moderate: 29.8%; severe: 56.4%). SPS was commonly used and was used more frequently as hyperkalemia severity increased (mild: 11.7%; moderate: 27.8%; severe: 45.3%). Over a third of patients across hyperkalemia severities received diuretics (mild: 32.7%; moderate: 37.1%; severe: 34.6%). Dialysis was used by 13.3% of patients overall and use increased with hyperkalemia severity (mild: 11.3%; moderate: 14.8%; severe: 22.5%). Treatment with patiromer was rare during the inpatient stay (<0.1% overall) and very few patients were prescribed SPS (0.1%) or patiromer (<0.1%) at discharge.
Related Knowledge Centers
- Arrhythmia
- Cardiac Arrest
- Hypoaldosteronism
- Kidney Failure
- Muscle Weakness
- Palpitations
- Paresthesia
- Potassium
- Serum
- Myalgia