Fast Five Quiz: Emergency Management of Hyperkalemia

A. Brent Alper, Jr, MD, MPH


March 23, 2022

Evaluation of vital signs is extremely important to determine the patient's hemodynamic stability and presence of cardiac arrhythmias (eg, extrasystoles, pauses, or bradycardia) related to hyperkalemia. The prevalence of cardiac arrhythmia increases directly with the degree of hyperkalemia. The danger in hyperkalemia cases is cardiac dysrhythmia, and often ventricular fibrillation or asystole.

Signs of renal failure during physical exam include edema, skin changes, and evidence of dialysis sites. Blood urea nitrogen and creatinine levels should be measured for evaluation of renal status. In addition, calcium levels should be checked if the patient has renal failure because hyperkalemia can exacerbate cardiac rhythm disturbances. Urinalysis should be performed to look for evidence of glomerulonephritis if renal insufficiency without a known cause is present.

During the physical exam, it is important to look for signs of trauma, including crush injuries, that will put patients at risk for rhabdomyolysis. Further testing is warranted to determine whether creatine kinase levels are elevated as well as urinalysis to see if myoglobinuria is present, manifested as tea-colored urine.

Hyperkalemic periodic paralysis is a rare condition presenting as temporary periods of severe muscle weakness or paralysis that begins in childhood and can continue until middle or even late adulthood. It presents as muscle weakness, ranging from mild weakness to paralysis. During these episodes, it is common to have higher than normal blood levels of potassium.

Learn more about the clinical presentation of hyperkalemia in the emergency department.


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