Hyperkalemia

HYPERKALEMIA

1. HYPERKALEMIA

2. Hyperkalemia is an elevated potassium level over 5 mEq /L. Hyperkalemia is rarein patints with normal kidney function but may develop in patients with renal insufficiency or renal failure. INCIDENCE:- 9-10% of potassium is excreted in the urine, patients with severe traumatic injuries- when potassium has intracellular

3. Spaces because of direct cellular injury ( eg -burns) develop hyperkalemia . The presence of shock in these patients compounds the problem because of low circulating vascular fluids and dimnished kidney function. RISK FACTORS:- Insufficient renal function Decreased urinary output

4. Rapid or excessive infusion of IV fluids with potassium should be infused by intravenous pumps. Prevention of hyperkalemia is essential because a rapid elevation of serum potassium could cause cardiac arrest. IV infusion of fluids with potassium chloride for patients with limited renal functionand low urine output should be

5. Carefully monitored and given very slowly and not at all. Solutions containing potassium should be infused by intravenous pumps. Urinary output should be assessed hourly when the patient is recieving potassium supplement. PATHOPHYSIOLOGY:- - Disturbance in cardiac conduction

6. Especially through the purkinje fibers and atrioventricular node, which may lead to ectopic beats, prolonged diastole. Increase in pacemaker and ectopic foci excitability . Cardiac arrest results with severe potassium elevation. Increased smooth muscle contraction, incraesed peristalsis.

7. Increased neuromuscular irritability of skeletal muscles to become weak owing to a depolarization block in the muscle. Usually due to pre-existing renal dysfunction, limits potassium excretion in the urine. Hyperkalemia is present. Oliguria or anuria causes an accumulation of potassium and other solutes, thus

8. Increasing the osmolality of body fluids. Oliguria or anuria causes an elevation of creatine and urea nitrogen in intravascular fluids. CLINICAL MANIFESTATIONS:- Cardiovascular:- First tachycardia and then bradycardia 2) Electrocardiographic changes:- peaked, narrow T-waves, wide QRS complex,

9. Depressed ST segment, widened PR interval Ectopic beats Hypotension Weakened cardiac contraction 2) Gastrointestinal:- Nausea, explosive diarrhea , intestinal colic, hyperactive bowel sounds (especially over splenic flexure)

10. 3) Neuromuscular Paresthesia (tingling sensation) Muscle weakness and later flaccid muscle paralysis, muscle cramps. 4) Renal:- Oliguria and late anuria LABORATORY FINDINGS:- Serum potassium>5mEq/L

11. Serum creatinine >1.5mEq/ dL Blood Urea Nitrogen>25mg/ dL MEDICAL MANAGEMENT:- Potassium elevation must be corrected before levels become severe. When the serum potassium level is 5 to 5.5 mEq /L, restriction of dietary potassium intake may be all that is needed. However, if the potassium excess is due to metabolic

12. acidosis, correcting the acidosis with sodium bicarbonate promotes potassium uptake into the cells. Improving urine output usually decreases the elevated serum potassium level. Potassium wasting diuretics can be used. When hyperkalemia is severe, immidiate actions are needed to avoid severe cardiac disturbances. These

13. These measures may include- Intravenous calcium gluconate infusions to decrease antagonistic effect of potassium excess on the myocardium. Infusion of insulin and glucose or sodium bicarbonate to promote potassium uptake into the cells. These methods usually provides temporary relief, and repeating them may not help.

14. As hyperkalemia persists or increases, a cation exchange resin such as polystyrene sulfonate ( Kayexalate ) may be given orally or rectally. This treatment stimulates the exchange of potassium ion for a sodium ion in the intestinal tract, the potassium ion is then excreted in the stool. Because Kayexalate can be constipating, sorbitol may be combined

15. With Kayexalate to prevent constipation and induce diarrhea . For rectal administration, it is given as retention enema. In marked renal failure, peritoneal dialysis or hemodialysis may be needed. NURSING MANAGEMENT:- Assessment:- Nursing assessment focuses on clinical manifestations of and laboratory findings

16. Associated with hyperkalemia . The serum potassium level must be closely monitored with high risk patients and patients who are recieving potassium supplements. A serum potassium level greater than 7 mEq /L result in cardiac disturbances. If this is not corrected or the level rises, acrdiac arrest can result. The ECG strips need to be assessed for

17. Narrowed, peaked T waves, deprerssed ST segment and widening of QRS and r interval. The flow rate of IV fluids with potassium should be closely monitored. A rapidly infused intravenous fluid with potassium can cause hyperkalemia . The potassium in intravenous fluid is irritating to the vein and subcutaneous tissue.

18. The nurse should assess for phlebitis and infilteration into subcutaneous tissies , which can cause sloughing and tissue necrosis. Nursing diagnosis:- Hyperkalemia r/t renal dysfunction, shock from traumatic injuries or burns. Expected outcomes:- The nurse will monitor the patient for return of serum

19. potassium level to normal, presence of adequate (30 ml/hr) urinary output, absence of signs and symptoms of neuromuscular changes, and apical pulse rate within normal range and without dysrrythmia . Implementation:- The nurse should have a high index of suspicion for those disorders that may cause hyperkalemia .

20. Assessment of signs and symptoms of hyperkalemia must be ongoing, and changes should be reported immidiately . Muscle weakness and flaccid muscle paralysis are symptoms of more severe hyperkalemia . The urine output should be closely monitored every 1 to 8 hours depending on patients’ condition. Changes

21. Eg - Urine output of less than 25 ml/hour or less than 60 ml/day should be reported immidiately . Most of the body’s excess potassium is excreted in urine. Methods prescribed for correction of hyperkalemia should be closely monitored by the nurse. If the patient is taking digitalis preperation and potassium correction is too rapid, hypokalemia may result. A hypokalemic

22. state could enhance the action of digitalis and cause digitalis toxicity. Serum potassium levels and signs and symptoms of hyperkalemia and hypokalemia need to be continually assessed. Nursing diagnosis:- Potential for dysrrythmia r/t hyperkalemia . Planning:- The nurse will monitor for dysrrythmias , assess electrocargraphic

23. Recordings and report changes that are related to cardiopulmonary resuscitation may be required but is seldom successful with severe hypokalemia because the heart muscle wil , respond. Insulin and glucose may be required but is seldom successful with severe hypokalemia because the heart muscle will not respond. Insulin and glucose may be

24. given to reduce potassium levels temporarily. The patient should be assessed for decreased cardiac output as as a result of bradycardia . The chest should be auscultated for crackles, the urine monitored for a decreased output , and the extremities assessed for peripheral edema . The nurse needs to report abnormal findings.

25. EVALUATION:- The patients’ status should be evaluated every hour if the patient has severe hyperkalemia . Revisions in the plan of care may be required. PATIENT EDUCATION:- The patient will need to closely adhere to the diet low in potassium if the hyperkalemia is a chronic problem ( eg -

26. Renal failure). Knowledge of food preperation is important because cooking styles can affect potassium levels.

27. THANK YOU