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Hyperkalemia

Written by kimmel52 on November 11, 2008 – 10:41 am

Electrolyte imbalances within the body can occur in response to many factors. When a person is dehydrated either from sickness or starvation, their electrolytes can become depleted. Certain medications can cause electrolyte imbalances as well as chronic diseases such as diabetes and renal failure. Electrolytes have a large role in balancing all metabolic reactions related to the delicate pH balance of the body, which is 7.35-7.45. Within this limited pH range all metabolic reactions can go to completion. For instance ATP can be released and produced, muscle contractions occur in simple or complex body movements, our thinking processes and those muscle contractions not in conscious control such as our beating heart and peristalsis of the bowel. When a particular electrolyte is either in to great or too small a concentration the pH of the body responds in kind to correct the imbalance by pulling from other sources in the body. When this happens the person begins to have symptoms that something is wrong. Sometimes the symptoms are barely noticeable while other times the person must be immediately hospitalized in intensive care. Hyperkalemia deals with an electrolyte imbalance in which there is too much potassium or (K+) in the body. When the serum potassium levels rise above 5.3 mEq/L or the blood pH drops below 7.35 the person is considered to be in a state of hyperkalemia. Hyperkalemia is diagnosed in up to 8% of hospitalized patients. Death can be as high as 67% if severe hyperkalemia is not treated quickly. Drugs are an underlying cause in 75% of inpatient cases. Some of the causes of hypekalemia can be seen in the table below;

Decreased Excretion

Excessive Ingestion

Interstitial Fluid Shift

Renal Failure (creatinine <10mL/min

Rapid IV infusion

Metabolic acidosis

Use of potassium sparing diuretics

Potassium supplements

Diabetic Ketoacidosis, K+ moves out into blood stream

Decreased aldosterone secretion

Metabolic acidosis

Anti hypertensives such as Beta Blocker and ACE Inhibitors

Signs and symptoms of hyperkalemia include muscle cramps, weakness in the lower extremities, nausea, diarrhea, low blood pressure, bradycardia, and an abnormal electrocardiogram. It is important to carefully monitor the elderly and small children for hyperkalemia. Normal occurrences like diarrhea and vomiting can be life threatening to infants and the elderly. This is due to the lack of fluids within them prior to the occurrence. Therefore careful observation for the above signs and symptoms can save a life. The first step in treatment is to determine whether life threatening cardiac toxicity is present and treat if required. Treatment is based on eliminating or decreasing potassium intake, shifting potassium form the ECF to the ICF, and improving renal and gastrointestinal potassium excretion. With cardiac arrhythmias or changes in the ECG, IV calcium gluconate is given first, then insulin or sodium bicarbonate is administered. If output does not exceed greater than 30 mL per hour then dialysis is usually started.

ECG abnormalities from hyperkalemia related to the P wave include either a low amplitude or wide and flattened to non discernible in severe states. The PR interval may be normal or prolonged, or not measurable if there is no P wave. The QRS complex is widened, and the T wave is tall and peaked. The QT interval is shortened and the ST segment may be elevated.

References

Lippincott Williams & Wilkins, ECG Interpretation an Incredibly Easy Pocket Guide., copyright 2006

Macklin, Murphy-Ende., Saunders Nursing Survival Guide Fluids and Electrolytes, Copyright 2006, Saunders Elsevier, St. Louis Missouri

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