Hyperkalemia
Hyperkalemia
Serum K+ > 4.8
Serum K+ < 6.0
Mild peaked T waves MAY NOT exceed amplitude of the QRS
Clearly defined, correctable cause of hyperkalemia
sCreatinine is no more than 2x baseline
ECG Changes (other than mildly peaked T waves) such as widened QRS, flattened or absent P waves, prolonged PR (from baseline) or any new arrhythmia
Need for patient to be "Shifted" prior to K+ elimination
Anuria, Oligouria
Unclear cause of Hyperkalmeia
Mental Status changes
Unable to take PO
Cardiac monitoring
BMP Q8hr
Medication
Furosemide 1 mg/kg (1.5 mg / kg if already taking) up to Q6 hours
Sodium Zirconium (Lokelma) 10 grams TID
IV Fluids (prefer LR, yes this has K+ in it, but its a trivial amount and NS can shift serum K+ higher)
Diet - Regular or Renal "pre-dialysis" diet
IF a patient develops further ECG changes, Arrhythmia, or K+ is worsening please use "Hyperkalemia" Order set to shift the patient and admit
Calcium Gluconate 1 gram IVPB
Insulin and Dextrose
Albuterol 10 mg (yes, that's a lot but its not a typo)
Disposition
K+ < 4.5 on 2 serial measurements (do not have to be spaced 8 hours apart)
Action taken to prevent recurrance
sCreatinine at or near baseline
Normal Urine output
Stable vital signs
Unstable vital signs or worsening clinical condition
k+ worsening, or not <4.5 after 18 hours of treatment in CDU
Not tolerating PO
Patient unable to ambulate
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