The Curbsiders Internal Medicine Podcast #137 Hyperkalemia Master Class with Joel Topf MD
Jan 28, 2019
Dr. Joel Topf, Chief of Nephrology at KashlakHospital, shares insightful tips on managing hyperkalemia. Topics discussed include common causes of hyperkalemia, the U-shaped curve of potassium levels and mortality, safe use of insulin, potassium binding resins and colonic necrosis, loop diuretics and fluids, fludrocortisone use, and high potassium diet and oral supplements.
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Initial Hyperkalemia Management Steps
- For potassium rising above 6, evaluate for urinary obstruction and stop offending drugs.
- Treat hyperkalemia driven by hyperglycemia with insulin; correct glucose without extra dextrose if hyperglycemic.
Prevent Hypoglycemia After Insulin
- Monitor blood glucose every 30 minutes for at least 6 hours after IV insulin to avoid hypoglycemia.
- Acute hyperkalemia treatments like insulin and albuterol last about 4 to 6 hours, requiring follow-up.
Loop Diuretics Plus Saline
- Safely give loop diuretics with saline to maintain euvolemia and enhance potassium excretion.
- Increased distal sodium delivery from fluids and diuretics promotes potassium secretion in the kidney.