Podcast : Hyperkalemia and Myth of Kayexalate

Contributor: Nick Tsipis, MD

Educational Pearls:

  • Acute hyperkalemia is characterized as serum K of 5.4 or higher in non-hemolyzed samples
  • Hyperkalemia is commonly associated with end stage renal disease, acute kidney injury or acute renal failure
  • Cardiac dysrhythmias are the primary concern with hyperkalemia, common EKG changes (and approximate serum levels) can include:
    • Peaked T waves that start to show at serum K of 6
    • Second sign is lengthening of PR and QRS intervals due to extended repolarization
    • Severe hyperkalemia manifests as a sine wave around serum of 8-9
  • Three approaches to treat hyperkalemia:
    • Stabilize cardiac membrane with calcium
    • Shift potassium  back into the cell, insulin and albuterol are common agents used.
    • Potassium binding for excretion
  • Cochrane review showed no significant effects of Kayexalate on serum K in 4 hours
  • Bowel necrosis is a rare adverse event that can occur with Kayexalate
  • More myths and misconceptions about hyperkalemia addressed in reference below!

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