#hyperkalemia

Instead of coming to work and bitching that we should have temporized a person's hyperkalemia sooner when they were ON DIALYSIS....

Maybe, just MAYBE when they arrived a day ago on your shift, also with hyperkalemia, you should have PUT AN HD LINE in the patient over the course of your 12 hour shift instead of repeatedly giving them insulin and albuterol until the cows come home.

I'm going to be 100% clear about this - refractory hyperkalemia requires dialysis. Period. You can temporize with insulin, albuterol, and a slew of other things but you're not FIXING the cause of hyperkalemia, nor are you actually getting rid of potassium from the body. Insulin pushes potassium into cells - it shifts things around and buys you time but it doesn't get rid of potassium from the blood. Things will equilibrate out eventually and the serum potassium will be high again. You need dialysis to remove K that most effectively in severe hyperkalemia.

Furthermore - if you have a patient, like this one, who came in as a trauma with horrible rhabdomyolysis and a CK >100,000, I can guarantee you that your patient's kidneys WILL fail and you'll need a line anyway. So maybe don't wait 10 hours when you know their kidneys are more myoglobin that actual kidneys at this point and just place the freaking line.

*sigh*

Rant complete.

In case you forgot - C BIG K DROP - Tx for hyperkalemia

Calcium gluconate - stabilizes cardiac membrane so your patient doesn't code. (Doesn't actually fix hyperkalemia).

Bicarb or Beta agonist (albuterol) - shifts K from serum to the cell for awhile . (Not a permanent solution)

Insulin - shifts K from the serum to the cell for a while. (Not a permanent solution)

Glucose - prevention of hypoglycemia when giving insulin

Kayexalate - actually a great way to get rid of K but your patient will have awful diarrhea. Not ideal in the critically ill and not so kind to patients conscious to experience it.

Diuretics - great way to get K out of the serum via urinary excretion. IV lasix, usually 40-80 mg to start.

My vestibular system has been tentatively diagnosed as Fucked! In two separate ways! Secondary endolymphatic hydrops (in only one ear, at the moment), and crystals in my inner ear fluid, aka BPPV.

This is good news, because both of these things are probably relatively-easily treatable in my case! The guy doing the tests actually showed me an exercise that he said could potentially entirely resolve the BPPV within a couple months.

The hydrops is more complicated, but he thought that it was likely that it was related to my issues with excess potassium: he’d only previously seen a correlation with excess sodium, but either could theoretically cause the problem. I cannot be trusted with Spironolactone or fruit.

Hyperkalemia