Short instructional video for clinicians describing recognition and initial management of hyperkalemia, especially in dialysis patients. Key recognition points include weakness, AMS, arrhythmias (peaked T waves, bradycardia, QRS widening/sine wave). First-line immediate therapy is IV calcium to stabilize cardiac membranes; temporizing potassium-shifting measures discussed are nebulized/inhaled albuterol and IV bicarbonate to buy time for dialysis.
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Another new protocol for you guys is hyperkalemia protocol. You'll recognize hyperkalemia patients because they'll typically be dialysis patients. So if we run on a dialysis patient and they're exhibiting any of the number of symptoms of hyperkalemia, such as weakness, altered mental status, arrhythmias, sometimes they get bradycardia, do an EKG on them, and if they still have pulses, we've got some time to do things. And typically what you'll see on EKG with hyperkalemia is very tall peak T waves, almost like they look like really sharp. So if it wasn't just paper, it could actually cut your finger. It gets really, really tall and sharp. That's one thing to look for, but another thing you might see on those folks when the hyperkalemia gets really bad and as you're getting towards cardiac arrest is they may have severe bradycardia. Those folks are probably hyperkalemic also. And the last thing you might see is their QRS widens and they start having what's like a sine wave on their ekg. We put a couple of examples of these in the protocol for you to look at. First line treatment for these people is to give them calcium. Now, calcium doesn't do anything to the potassium level in the bloodstream, but what it does is it immediately stabilizes the Purkinje fibers in the heart so that they're not so susceptible to the effects of the hyperkalemia on the cardiac rhythm pattern. So calcium is a first line drug for those folks. And if they go into cardiac arrest, calcium, again is first line drug for those folks.
Albuterol is another medication we can use for our hyperkalemic patients. I know we typically use it for those having bronchospasm, but albuterol also has the effect of causing potassium in the blood to be driven into the cells. So it's another good temporizing measure for our folks with hyperkalemia and will be part of the hyperkalemia cocktail.
The other drug we can give them is bicarb. And the reason for bicarb is because the body constantly tries to maintain both electrical and ph neutrality. Meaning when you give bicarb, what's going to happen is the body's going to sense that you've raised the ph level in the bloodstream. So what it's going to want to do is take hydrogen ions from inside the cell and put them into the bloodstream to counteract the bicarb. Now, because the hydrogen ion is positively charged in order that you don't turn into a magnet or conduct electricity. The body then has to take a positively charged molecule out of the bloodstream. So potassium is positively charged. So what happens is you end up exchanging hydrogen from inside the cell and you take potassium outside of the bloodstream. So when you give bicarb, it sort of sucks the potassium temporarily out of the bloodstream, where it can no longer affect the heart. It doesn't cure them, but does buy us some time to get them to dialysis. It does not work as fast as the calcium, though. So the calcium is our first line drug because that will work immediately. And then you hit them with the bicarb, which will tend to start sucking the potassium out of the bloodstream and into the cells.
