Electrolyte Disorders

Hyperkalemia
●​ ↓ Renal elimination
○​ Na reabsorption
○​ ↓ delivery of sodium and water to distal tubules
○​ Reduced circulating blood volume
○​ Renal failure
○​ ↓ Aldosterone - Endocrine disorders (Addison’s disease)
●​ Drugs that ↓ potassium excretion
○​ Potassium sparing diuretics
○​ ACEs and ARBs
●​ Shift Potassium outside cells (Acidosis ↑ Potassium)
●​ EKG: Hypopolarization, Peaked T waves

Treatment of Acute Hyperkalemia:
●​ Antagonize Adverse Cardiac Effects: Calcium gluconate/Chloride
●​ Reverse symptoms:
○​ Shift K into cells
■​ Regular Insulin 10 units
■​ D5W
■​ Beta-Agonists (Albuterol 10-20 mg)
■​ Sodium Bicarbonate 50-100 mEq
●​ Return Serum and Total Body Stores to Normal:
○​ Non-pharmacologic: Dialysis
○​ Pharmacologic: Furosemide 20-40 mg IV

Treatment of Chronic Hyperkalemia:
●​ Return serum and total body stores to normal
●​ Reverse underlying process
●​ Non-pharmacologic: Diuresis
●​ Pharmacologic:
○​ Diuretics: Furosemide 20-40 mg by mouth or Bumetanide 1-2 mg by mouth
○​ Increase GI elimination: Potassium Binders
■​ Patiromer and Sodium Cyclosilicate (Powder packets)
●​ Patiromer
○​ Calcium-Potassium ion exchange
○​ Also binds Mg
○​ No sodium content
○​ Dose: 8.4 g once daily (max 25.2 g daily)
○​ Side effects: GI, hypomagnesemia
○​ Interactions: Separate by at least 3 hours from other meds