Part of this prolongation was due to a prominent U wave. The appearance of the T waves was unusual with a prolongation of the descending limb of the T wave, merging into the next P wave. There were peaked T waves in the precordial leads. He was admitted to the intensive care unit for management of sepsis and initiation of chemotherapy.Ī 12‐lead ECG showed normal sinus rhythm at 80 beats/min ( Fig. Computed tomography of his abdomen revealed Richter's transformation of his CLL. His abdomen was tender, distended, and the skin was mottled. His temperature was 37.9☌ and he required a FIO 2 of 60% to maintain a SaO 2 greater than 92%. On examination his blood pressure was 94/62 mmHg, his heart rate was 111 beats/min, and his respiratory rate was 22/min. He had recently been treated with prednisone for warm autoimmune hemolytic anemia. These should be avoided in patients who have a SCr of 5.5 meq/L or a Clcr of 30ml/min or less.ġ.5 – Signs or symptoms of medical conditions, healthy physiology, etiology of diseases, or pathophysiologyĢ.1 – Pharmacology, mechanism of action, or therapeutic classģ.A 62‐year‐old man with a history of chronic lymphocytic leukemia (CLL) presented to the Emergency Department complaining of a 4‐day history of vomiting and abdominal pain. Alsosterone or eplerenone, aldosterone antagonists that "sound" like steroids and are often used in management of heart failure, are also known as potassium-sparing diuretics and can induce hyperkalemia. Also, remember that any exogenous potassium supplementation should be stopped in patients with hyperkalemia as this is a common reason for inducing it in the first place!ĭexamethasone (brand Decadron) is used in many conditions but is not used specifically for the treatment of hyperkalemia, making answer choice E incorrect. This makes answer choice C correct.Ī good way to remember which agents can be used is C A BIG K DROP (C-calcium, A-albuterol, B-bicarbonate, IG-insulin with glucose/dextrose, K-Kayexalate, Drop-Diuretics/Dialysis). In some cases, dialysis may be considered, especially if the patient already is a chronic dialysis patient with access. Lastly, agents to eliminate potassium from the body include loop diuretics or potassium binders such as Kayexalate (sodium polystyrene sulfonate) or Lokelma (sodium zirconium cyclosilicate). Albuterol, while a correct option ( answer A), is rarely used due to need to administer many nebulized doses to ensure shift of potassium intracellularly which can also have significant tachycardia. This makes answer choice D incorrect as this is the wrong route of administration. Insulin is the preferred next agent and is given intravenously in hyperkalemia treatment to promote more consistent bioavailability. These include high-dose albuterol, insulin regular 10 units IV (with dextrose to prevent hypoglycemia), and/or bicarbonate administration. The next group of agents used in hyperkalemia shift potassium into the cells. Typically calcium gluconate is given over calcium chloride as the latter is often relegated to code situations due to increased risk of burning/irritation on administration and is preferred to give via central line. Our patient has peaked T waves so calcium should be administered making answer choice B is correct. This stabilizes the cardiac membrane and gives the other agents time to work. The first agent that should be used is calcium if there are EKG changes. There are many agents used in the treatment of hyperkalemia. While concentrations just above the normal limit (around 5 meq/L) can be managed conservatively, those above 5.5 meq/L with acute renal dysfunction, above 6.5 meq/L, or with EKG changes should be managed emergently. Hyperkalemia (elevated potassium concentrations in the blood) is sometimes an emergency that requires prompt treatment due to the risk of developing arrhythmias or sudden cardiac death. Insulin Regular 10 units SQ plus 50mL D50W IV Which of the following agents could potentially be used in the management of AD's hyperkalemia? Select all that apply.ĭ. The medical resident wants to know what agents they should use to treat AD's hyperkalemia. The patient's baseline SCr is 1.2 meq/L and currently is 3.0 meq/L. Initial labs show a potassium conentration of 7.1 mEq/L. AD is a 73-year-old female who comes into the emergency room overnight complaining of muscle weakness, nausea, vomiting, and shortness of breath.
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