Penanganan Hiperkalemia

Management of HyperkalemiaAristo2015DEFINITIONS

Hyperkalemia is defined as serum potassium greater than 5.5 mEq/LIt is further categorized as:Mild = serum potassium 5.5 - 6 mEq/LModerate = serum potassium 6.1 - 6.9 mEq/LSevere= serum potassium > 6.9 mEq/LBAckgroundPotassium is intracellular cation 98% and only 2% in the extracellular fluid The Na+/K+- Pump 3Na+ out : 2K+ in60-75% K is reabsorbed in the proximal tubule by diffusionRenal maintain K homeostasis until GFR < 15 ml/min/1.73 m2.Lehnhar, Kemper, Pathogenesis, diagnosis and management of hyperkalemia, Pediatr Nephrol (2011) 26:377384

Etiologi Excessive potassium intakeImpaired elimination of potassium from bodyIncreased shift of potassium to extracellular spaceCLINICAL EFFECTS OF HYPERKALEMIA

Neuromuscular : Weakness, Paresthesi, and Ascending paralysis.

ECG changes :Tall TLoss of P WaveWidening QRS ComplexCardiac arrthymias:Sinus bradycardia, Sinus arrest, Ventricular fibrillation, Asystole.

Goal TherapyStabilize cardiomycyte cell membran to prevent aritmiaIncrease shift K into the cellEnhance eliminating K from bodyEvaluate potential toxicities and initiate ECG monitoringSevere hyperkalemia/shows ECG changes, ICU immediately.Ca-Gluconate 10% cardiac symptoms to stabilize membrane potentialCI: digoxin-intoxication, hypercalcemic states.Increase K shift to intracellular space

Insulin + dextrose 25 50 mgBeta-adrenergic agonists (salbutamol, reproterol) decrease of 1.6- 1.7 mmol/l after 2 hSodium bicarbonate, metabolic asidosis. Increase potassium excretion

Loop diuretics (furosemide)

Ion-exchange resins (Kayexalate)

Hemodialysis1 mEq in 60 s2 mEq in 180 sImmediately eliminate sources of potassium intakeStop oral or parenteral potassium supplements.Stop all drugs that might cause hyperkalemia.Diet avoid potassium-rich foods especially in CKD

Management of Hyperkalemia

Mushiyakh, Dangaria, Qavi, et all, Treatment and pathogenesis of acute hyperkalemia, Journal of Community Hospital Internal Medicine Perspectives ,2011.Terima kasihManagement of hyperkalemia