the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then ask yourself: how did the patient get hyper K in the first place? Often, it’s b/c of missed HD. But don’t […]

Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possibly answer this phenomenon. This is the way we normally think of the anion gap (composed of anions like phosphate, albumin, […]

Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium to review the physiology of fluid resuscitation in the setting of hyper K (per request by Dr Hickey). This has been debunked […]

You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered by cells:How do our treatments shift K+ intracellularly? … Key: Na-K-ATPase! 3Na+ out, 2K+ IN! And stimulated by the β2 and insulin […]

You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate was in the 150s — no time for a full set of vitals or an EKG. You adeptly obtain these; the […]