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Hyperkalemia in Emergency Medicine Follow-up

  • Author: David Garth, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Dec 16, 2015
 

Further Outpatient Care

Adjust diet to decrease potassium dietary load.

Adjust medications that predispose to or exacerbate hyperkalemia.

Repeat potassium level tests in 2-3 days.

Reevaluate renal function if signs of renal insufficiency are present.

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Further Inpatient Care

Order continuous cardiac monitoring for patients who are hyperkalemic.

Definitive therapy is dialysis in patients with renal failure or when pharmacologic therapy is not sufficient. Any patient with significantly elevated potassium levels should undergo dialysis, as pharmacologic therapy alone is not likely to adequately bring down the potassium levels in a timely fashion.

Monitor serial potassium levels.

Resolve acid-base problems.

Correct coexistent electrolyte disturbances.

Treat digoxin toxicity, if present.

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Transfer

If unable to correct hyperkalemia with pharmacologic therapy and dialysis is unavailable, stabilize the patient and transfer to a center where dialysis can be performed.

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Deterrence/Prevention

Avoid foods high in potassium.

Avoid medications that predispose to hyperkalemia.

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Complications

Life-threatening cardiac arrhythmias may ensue.

Hypokalemia may result from the treatment of hyperkalemia.

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Prognosis

Expect full resolution with correction of the underlying etiology.

Reduction of plasma potassium should begin within the first hour of initiation of treatment.

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Patient Education

Pursue diet modification.

Discontinue use of medications that may worsen hyperkalemia.

Encourage adherence to dialysis schedule if patient is noncompliant.

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Contributor Information and Disclosures
Author

David Garth, MD Attending Physician, Department of Emergency Medicine, Mary Washington Hospital

David Garth, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References
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Widened QRS complexes in hyperkalemia.
Widened QRS complexes in a patient whose serum potassium level was 7.8 mEq/L.
ECG of a patient with pretreatment potassium level of 7.8 mEq/L and widened QRS complexes after receiving 1 ampule of calcium chloride. Notice narrowing of QRS complexes and reduction of T waves.
 
 
 
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