Hyperkalemia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents for ‍newknown hyperkalemia



Lab results:

K ‍ ‍hemolyzed

Na ‍ ‍normal

Cl ‍ ‍normal

BUN ‍ ‍normal, creatinine ‍ ‍normal

Albumin ‍ ‍normal

Ca ‍ ‍normal, Mg ‍ ‍normal, Phosphate ‍ ‍normal

Urinalysis ‍ ‍normal



Associated symptoms: *Try using right-click for negatives*

‍none

‍fatigue

‍weakness

‍numbness

‍tingling

‍palpitations

‍near-syncope

‍syncope

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍



Contributing factors:

‍high-potassium diet

‍non-adherence to medications

no history of: ‍kidney disease, ‍heart failure, ‍diabetes, ‍Addison's disease

no use of: ‍Potassium supplements, ‍potassium-sparing diuretics, ‍ACEI or ARB, ‍Beta-blockers, ‍new medications





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady





ASSESSMENT:

‍Hyperkalemia ‍likelysuspectedpossible

DDx: acute kidney injury, chronic kidney disease, dehydration, diarrhea, excessive potassium intake, medication-induced hyperkalemia, potassium supplements, ACE inhibitors, ARBs, potassium-sparing diuretics, NSAIDs, beta-blocker use, digitalis toxicity, heparin use, pseudohyperkalemia due to hemolysis in blood sample, hemolysis, rhabdomyolysis, tumor lysis syndrome, metabolic acidosis, hyperglycemia, Addison's disease, transfusion, familial hyperkalemic periodic paralysis





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍BUN, ‍calcium, ‍phosphate, ‍albumin, ‍PTH, ‍cortisol, ‍aldosterone, ‍renin

- Urine: ‍urinalysis, ‍urine electrolytes

- ECG

Treatments:

- ‍Calcium gluconate

- ‍Sodium bicarbonate

- ‍Inѳulin and glucose

- ‍Salbutamol

- ‍Sodium polystyrene sulfonate

- ‍Hemodialysis

- Stop medications: potassium supplements, potassium-sparing diuretics, ACE iѮhibitors, ARBs, beta blockers, NSAIDs

- Dietary modifications: ‍low potassium diet

Further care:

- Referral to nephrologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as palpitations, muscle weakness, or numbness

- Referral to ER if severe palpitations, chest pain, shortness of breath, or loss of consciousness occurs