Hyperkalemia

Introduction:

Hyperkalemia is an elevated level of potassium in the blood. Dietary intake is the
main source of potassium. Patients are at risk for hyperkalemia when there is exces-
sive ingestion of potassium-rich foods or salt substitutes, they are on medications
that cause potassium retention (ACE inhibitors, angiotensin receptor blockers,
potassium-sparing diuretics such as amiloride or spironolactone, NSAIDs, tri-
methoprim, pentamidine), or there is excess release of potassium from the cells
(hemolysis, acidosis, low insulin levels, beta blocker use, digoxin overdose,
succinylcholine, or rhabdomyolysis).

PROGNOSIS
As potassium levels rise, the risk of cardiac arrhythmias also increases. An extreme
elevation creates a medical emergency. Correction or management of the underly-
ing cause is necessary to help restore the electrolyte balance.

SIGNS AND SYMPTOMS

• Weakness and dizziness due to neuromuscular changes
• Abdominal distention
• Nausea, vomiting, diarrhea due to change in membrane potential on GI system
• Palpitations due to arrhythmias
• Arrhythmias due to changes in normal cardiac conduction
• Cardiac arrest

TREATMENT

The treatment choices will depend on the severity of the potassium elevation.
Decreasing further intake, enhancing renal excretion, and cellular uptake are all
goals of treatment.
• Monitor cardiac rhythm.
• Administer intravenous insulin and glucose to move potassium from extra-
cellular fluid to intracellular fluid.
• Administer calcium gluconate intravenously.
• Administer NaHCO3 to move potassium from extracellular fluid to intracel-
lular fluid.
• Administer diuretics to remove potassium from body.
• Administer kayexalate to remove potassium from body via GI tract.
• Monitor electrolyte levels.

• Restrict potassium intake.
• Dialysis for severe elevations.

NURSING DIAGNOSIS
• Decreased cardiac output
• Risk for imbalanced fluid volume
• Activity intolerance
• Altered bowel elimination

NURSING INTERVENTIONS
• Monitor vital signs.
• Monitor cardiac rhythm.
• Monitor cardiovascular status for regularity of rhythm, rate, heart sounds, and
peripheral pulses.
• Monitor abdomen for bowel sounds, distention, and pain.
• Monitor intravenous site for redness, swelling, and pain.
• Teach patient about medications and diet:
• Avoid foods that are high in potassium.
• Avoid salt substitutes (most are potassium-based).