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Weant KA, Gregory H. Acute Hyperkalemia Management in the Emergency Department. Adv Emerg Nurs J 2024; 46:12-24. [PMID: 38285416 DOI: 10.1097/tme.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Acute hyperkalemia is characterized by high concentrations of potassium in the blood that can potentially lead to life-threatening arrhythmias that require emergent treatment. Therapy involves the utilization of a constellation of different agents, all targeting different goals of care. The first, and most important step in the treatment of severe hyperkalemia with electrocardiographic (ECG) changes, is to stabilize the myocardium with calcium in order to resolve or mitigate the development of arrythmias. Next, it is vital to target the underlying etiology of any ECG changes by redistributing potassium from the extracellular space with the use of intravenous regular insulin and inhaled beta-2 agonists. Finally, the focus should shift to the elimination of excess potassium from the body through the use of intravenous furosemide, oral potassium-binding agents, or renal replacement therapy. Multiple nuances and controversies exist with these therapies, and it is important to have a robust understanding of the underlying support and recommendations for each of these agents to ensure optimal efficacy and minimize the potential for adverse effects and medication errors.
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Affiliation(s)
- Kyle A Weant
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia (Dr Weant); and Department of Pharmacy, University of North Carolina Health, Chapel Hill (Dr Gregory)
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Ogrodny A, Jaffey JA, Kreisler R, Acierno M, Jones T, Costa RS, da Cunha A, Westerback E. Effect of inhaled albuterol on whole blood potassium concentrations in dogs. J Vet Intern Med 2022; 36:2002-2008. [PMID: 36178135 DOI: 10.1111/jvim.16552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Albuterol by inhalation (IH) is a common treatment for hyperkalemia in humans but its effect on blood potassium concentrations in dogs is unknown. OBJECTIVE Determine whether albuterol (IH) decreases blood potassium concentrations in healthy normokalemic dogs and if effects are dose-dependent. ANIMALS Ten healthy dogs. METHODS Prospective, crossover experimental study. Albuterol sulfate was administered at a low-dose (90 μg) in phase I and, 7 days later, high-dose (450 μg) in phase II. Blood potassium and glucose concentrations (measured via blood gas analyzer) and heart rates were obtained at baseline and then 3, 5, 10, 15, 30, 60, 90, 120, 180, and 360 minutes after inhaler actuation. RESULTS Blood potassium concentrations decreased rapidly after albuterol delivery with a significant reduction compared to baseline within 30 minutes in both phases (P = .05). The potassium nadir concentration of phase I occurred at 60 minutes (mean, SD; 4.07 mmol/L, 0.4) and was significantly decreased from baseline, (4.30 mmol/L, 0.3; t(9) = 2.40, P = .04). The potassium nadir concentration of phase II occurred at 30 minutes (mean, SD; 3.96 mmol/L, 0.39) and was also significantly decreased from baseline, (4.33 mmol/L, 0.4; t(9) = 2.22, P = .05). The potassium nadir concentration decreased by 0.1 mmol/L for each 10 μg/kg increase in dose of albuterol (P = .01). Five dogs had ≥1 hyperglycemic measurement (ie, >112 mg/dL). No median heart rate was tachycardic nor was any mean blood glucose concentration hyperglycemic at any time point. CONCLUSION AND CLINICAL IMPORTANCE Albuterol IH decreases blood potassium concentrations in a dose-dependent manner without clinically meaningful alterations to heart rate or blood glucose concentrations in healthy dogs. The mean decrease in potassium concentration at the high-dose of albuterol was modest (0.38 mmol/L).
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Affiliation(s)
- Andrezej Ogrodny
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Jared A Jaffey
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Rachael Kreisler
- Department of Primary Care, Shelter, and Community Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Mark Acierno
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Teela Jones
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Renata S Costa
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Anderson da Cunha
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Emily Westerback
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
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Rafique Z, Peacock F, Armstead T, Bischof JJ, Hudson J, Weir MR, Neuenschwander J. Hyperkalemia management in the emergency department: An expert panel consensus. J Am Coll Emerg Physicians Open 2021; 2:e12572. [PMID: 34632453 PMCID: PMC8485984 DOI: 10.1002/emp2.12572] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/18/2021] [Accepted: 09/16/2021] [Indexed: 01/11/2023] Open
Abstract
Hyperkalemia is a common electrolyte abnormality identified in the emergency department (ED) and potentially fatal. However, there is no consensus over the potassium threshold that warrants intervention or its treatment algorithm. Commonly used medications are at best temporizing measures, and the roles of binders are unclear in the emergent setting. As the prevalence of comorbid conditions altering potassium homeostasis rises, hyperkalemia becomes more common, and hence there is a need to standardize management. A panel was assembled to synthesize the available evidence and identify gaps in knowledge in hyperkalemia treatment in the ED. The panel was composed of 7 medical practitioners, including 5 physicians, a nurse, and a clinical pharmacist with collective expertise in the areas of emergency medicine, nephrology, and hospital medicine. This panel was sponsored by the American College of Emergency Physicians with a goal to create a consensus document for managing acute hyperkalemia. The panel evaluated the evidence on calcium for myocyte stabilization and potassium shifting and excretion. This article summarizes information on available therapies for hyperkalemia and proposes a hyperkalemia treatment algorithm for the ED practitioner based on the currently available literature and highlights diagnostic pitfalls and evidence gaps.
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Affiliation(s)
- Zubaid Rafique
- Baylor College of MedicineDepartment of Emergency MedicineBen Taub General HospitalHoustonTexasUSA
| | - Frank Peacock
- Baylor College of MedicineDepartment of Emergency MedicineBen Taub General HospitalHoustonTexasUSA
| | | | - Jason J. Bischof
- The Ohio State UniversityDepartment of Emergency MedicineColumbusOhioUSA
| | - Joanna Hudson
- The University of Tennessee Health Science CenterDepartments of Clinical Pharmacy and Translational Science & Medicine (Nephrology)MemphisTennesseeUSA
| | - Matthew R. Weir
- Division of NephrologyDepartment of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - James Neuenschwander
- The Ohio State UniversityDepartment of Emergency MedicineColumbusOhioUSA
- Genesis Healthcare SystemDepartment of Emergency MedicineZanesvilleOhioUSA
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Almalki B, Cunningham K, Kapugi M, Kane C, Agrawal A. Management of hyperkalemia: A focus on kidney transplant recipients. Transplant Rev (Orlando) 2021; 35:100611. [PMID: 33711778 DOI: 10.1016/j.trre.2021.100611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/15/2022]
Abstract
Hyperkalemia is a frequent complication among kidney transplant recipients that can lead to fatal arrhythmias. The causes of hyperkalemia post kidney transplant are multifactorial and often are drug-induced, and include decreased glomerular filtration rate, tubular dysfunction, and impaired sodium delivery in the distal nephron. This review will discuss pathophysiology and recent updates in the management of both acute and chronic hyperkalemia with a focus on kidney transplant recipients.
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Affiliation(s)
- Bassem Almalki
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, United States.
| | - Kathleen Cunningham
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Michelle Kapugi
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Clare Kane
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Akansha Agrawal
- Department of Nephrology, Northwestern Memorial Hospital, Chicago, IL, United States
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Barbance O, De Bels D, Honoré PM, Bargalzan D, Tolwani A, Ismaili K, Biarent D, Redant S. Potassium disorders in pediatric emergency department: Clinical spectrum and management. Arch Pediatr 2020; 27:146-151. [PMID: 31955956 DOI: 10.1016/j.arcped.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/18/2019] [Accepted: 12/30/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Potassium abnormalities are frequent in intensive care but their incidence in the emergency department is unknown. AIM We describe the spectrum of potassium abnormalities in our tertiary-level pediatric emergency department. METHODS Retrospective case-control study of all the patients admitted to a single-center tertiary emergency department over a 2.5-year period. We compared patients with hypokalemia (<3.0mEq/L) and patients with hyperkalemia (>6.0mEq/L) against a normal randomized population recruited on a 3:1 ratio with potassium levels between 3.5 and 5mEq/L. RESULTS Between January 1, 2013 and August 31, 2016 we admitted 108,209 patients to our emergency department. A total of 9342 blood samples were tested and the following potassium measurements were found: 60 cases of hypokalemia (2.8±0.2mEq/L) and 55 cases of hyperkalemia (6.4±0.6mEq/L). In total, 200 patients with normokalemia were recruited (4.1±0.3mEq/L). The main causes of the disorders were non-specific: lower respiratory tract infection (23%) and fracture (15%) for hypokalemia, lower respiratory tract (21.8%) and ear-nose-throat infections (20.0%) for hyperkalemia. Patients with hyperkalemia had an elevated creatinine level (0.72±1.6 vs. 0.40±0.16mg/dL, P<0.0001) with lower bicarbonate (19.4±3.8 vs. 21.8±2.8mmol/L, P=0.0001) and higher phosphorus levels (1.95±0.6 vs. 1.42±0.27mg/dL, P=0.0001). Patients with hypokalemia had an elevated creatinine level (0.66±0.71 vs. 0.40±0.16mg/dL, P<0.0001) and a lower phosphorus level (1.12±0.31 vs. 1.42±0.27mg/dL, P=0.0001). We did not observe significant differences in pH, PCO2, base excess and lactate, or in the mean duration of hospitalization in general wards and pediatric intensive care units according to the PIM and PRISM scores. DISCUSSION Dyskalemia is rare in emergency department patients: 0.64% for hypokalemia and 0.58% for hyperkalemia. This condition could be explained by a degree of renal failure due to transient volume disturbance. The main mechanism is dehydration due to digestive losses, polypnea in young patients, and poor intake. In the case of hypokalemia, poor intake and digestive losses could be the main explanation. These disorders resolve easily with feeding or perfusion and do not impair development. CONCLUSION Dyskalemia is rare in emergency department patients and is easily resolved with feeding or perfusion. A plausible etiological mechanism is a transient volume disturbance. Dyskalemia is not predictive of poor development in the emergency pediatric population.
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Affiliation(s)
- O Barbance
- Emergency Department, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - D De Bels
- Departments of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - P M Honoré
- Departments of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - D Bargalzan
- Clinical Biology, CHU de Brugmann-Brugmann University Hospital, place Van Gehuchtenplein, 4, 1020 Brussels, Belgium
| | - A Tolwani
- Division of Nephrology, University of Alabama at Birmingham School of Medicine, Birmingham. AL, USA
| | - K Ismaili
- Department of Nephrology, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - D Biarent
- Emergency Department, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - S Redant
- Emergency Department, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Departments of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
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Rafique Z, Chouihed T, Mebazaa A, Frank Peacock W. Current treatment and unmet needs of hyperkalaemia in the emergency department. Eur Heart J Suppl 2019; 21:A12-A19. [PMID: 30837800 PMCID: PMC6392420 DOI: 10.1093/eurheartj/suy029] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hyperkalaemia is a common electrolyte abnormality and can cause life-threatening cardiac arrhythmia. Even though it is common in patients with diabetes, heart failure, and kidney disease, there is poor consensus over its definition and wide variability in its treatment. Medications used to treat hyperkalaemia in the emergent setting do not have robust efficacy and safety data to guide treatment leading to mismanagement due to poor choice of some agents or inappropriate dosing of others. Moreover, the medications used in the emergent setting are at best temporizing measures, with dialysis being the definitive treatment. New and old k binder therapies provide means to excrete potassium, but their roles are unclear in the emergent setting. Electrocardiograms are the corner stones of hyperkalaemia management; however, recent studies show that they might manifest abnormalities infrequently, even in severe hyperkalaemia, thus questioning their role. With an aging population and a rise in rates of heart and kidney failure, hyperkalaemia is on the rise, and there is a need, now more than ever, to understand the efficacy and safety of the current medications and to develop newer ones.
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Affiliation(s)
- Zubaid Rafique
- Baylor College of Medicine, Ben Taub General Hospital, Houston, TX, USA
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, France; Clinical Investigation Center-Unit 1433; INSERM U1116, University of Lorraine, Nancy, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France
| | - W Frank Peacock
- Baylor College of Medicine, Ben Taub General Hospital, Houston, TX, USA
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Saw HP, Chiu CD, Chiu YP, Ji HR, Chen JY. Nebulized salbutamol diminish the blood glucose fluctuation in the treatment of non-oliguric hyperkalemia of premature infants. J Chin Med Assoc 2019; 82:55-59. [PMID: 30839405 DOI: 10.1016/j.jcma.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperkalemia is a risky and potentially life-threatening condition in pre-term infants. Glucose-insulin infusion has been considered a major therapeutic way for non-oligouric hyperkalemia but affects the stability of blood sugar level. We aimed to evaluate the effectiveness of salbutamol nebulization compared to glucose-insulin infusion for the treatment of non-oliguric hyperkalemia in premature infants. METHODS Forty premature infants (gestation age ≤36 weeks) with non-oliguric hyperkalemia (central serum potassium level greater than 6.0 mmol/L) within 72 h of birth were enrolled in this study. These infants were randomly assigned into two groups. One group received a regular insulin bolus with glucose infusion (Group A; n = 20), and the other received salbutamol (Ventolin) by nebulization (Group B; n = 20). Potassium level, blood sugar, heart rate, and blood pressure were recorded for each group before treatment and at 3, 12, 24, 48, and 72 h post-treatment. RESULTS The serum potassium levels were reduced after treatment in both groups. No significant changes in heart rate or blood pressure were observed in either group. The fluctuation in glucose levels was gentler in the salbutamol-treated group than in the glucose-insulin infusion group. CONCLUSION Salbutamol nebulization is not only as effective as glucose-insulin infusion for treating non-oliguric hyperkalemia in premature infants but can avoid potential side effects such as vigorous blood glucose fluctuations.
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Affiliation(s)
- Hean-Pat Saw
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Chung Kang Branch, Cheng Ching General Hospital, Taichung, Taiwan, ROC
| | - Cheng-Di Chiu
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan, ROC
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, ROC
- Stroke Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - You-Pen Chiu
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
- Stroke Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Hui-Ru Ji
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
- Stroke Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Jia-Yuh Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
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Robert T, Algalarrondo V, Mesnard L. Hyperkaliémie sévère ou menaçante : le diable est dans les détails. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13546-015-1125-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Batterink J, Cessford TA, Taylor RAI. Pharmacological interventions for the acute management of hyperkalaemia in adults. Cochrane Database Syst Rev 2015; 10:CD010344. [PMID: 35658162 PMCID: PMC9578550 DOI: 10.1002/14651858.cd010344.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hyperkalaemia is a potentially life-threatening electrolyte disturbance which may lead to cardiac arrhythmias and death. Renal replacement therapy is known to be effective in treating hyperkalaemia, but safe and effective pharmacological interventions are needed to prevent dialysis or avoid the complications of hyperkalaemia until dialysis is performed. OBJECTIVES This review looked at the benefits and harms of pharmacological treatments used in the acute management of hyperkalaemia in adults. This review evaluated the therapies that reduce serum potassium as well as those that prevent complications of hyperkalaemia. SEARCH METHODS We searched Cochrane Kidney and Transplant's Specialised Register to 18 August 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs looking at any pharmacological intervention for the acute management of hyperkalaemia in adults were included in this review. Non-standard study designs such as cross-over studies were also included. Eligible studies enrolled adults (aged 18 years and over) with hyperkalaemia, defined as serum potassium concentration ≥ 4.9 mmol/L, to receive pharmacological therapy to reduce serum potassium or to prevent arrhythmias. Patients with artificially induced hyperkalaemia were excluded from this review. DATA COLLECTION AND ANALYSIS All three authors screened titles and abstracts, and data extraction and risk of bias assessment was performed independently by at least two authors. Studies reported in non-English language journals were translated before assessment. Authors were contacted when information about results or study methodology was missing from the original publication. Although we planned to group all studies of a particular pharmacological therapy regardless of administration route or dose for analysis, we were unable to conduct meta-analyses because of the small numbers of studies evaluating any given treatment. For continuous data we reported mean difference (MD) and 95% confidence intervals (CI). MAIN RESULTS We included seven studies (241 participants) in this review. Meta-analysis of these seven included studies was not possible due to heterogeneity of the treatments and because many of the studies did not provide sufficient statistical information with their results. Allocation and blinding methodology was poorly described in most studies. No study evaluated the efficacy of pharmacological interventions for preventing clinically relevant outcomes such as mortality and cardiac arrhythmias; however there is evidence that several commonly used therapies effectively reduce serum potassium levels. Salbutamol administered via either nebulizer or metered-dose inhaler (MDI) significantly reduced serum potassium compared with placebo. The peak effect of 10 mg nebulised salbutamol was seen at 120 minutes (MD -1.29 mmol/L, 95% CI -1.64 to -0.94) and at 90 minutes for 20 mg nebulised salbutamol (1 study: MD -1.18 mmol/L, 95% CI -1.54 to -0.82). One study reported 1.2 mg salbutamol via MDI 1.2 mg produced a significant decrease in serum potassium beginning at 10 minutes (MD -0.20 mmol/L, P < 0.05) and a maximal decrease at 60 minutes (MD -0.34 mmol/L, P < 0.0001). Intravenous (IV) and nebulised salbutamol produced comparable effects (2 studies). When compared to other interventions, salbutamol had similar effect to insulin-dextrose (2 studies) but was more effective than bicarbonate at 60 minutes (MD -0.46 mmol/L, 95% CI -0.82 to -0.10; 1 study). Insulin-dextrose was more effective than IV bicarbonate (1 study) and aminophylline (1 study). Insulin-dextrose, bicarbonate and aminophylline were not studied in any placebo-controlled studies. None of the included studies evaluated the effect of IV calcium or potassium binding resins in the treatment of hyperkalaemia. AUTHORS' CONCLUSIONS Evidence for the acute pharmacological management of hyperkalaemia is limited, with no clinical studies demonstrating a reduction in adverse patient outcomes. Of the studied agents, salbutamol via any route and IV insulin-dextrose appear to be most effective at reducing serum potassium. There is limited evidence to support the use of other interventions, such as IV sodium bicarbonate or aminophylline. The effectiveness of potassium binding resins and IV calcium salts has not been tested in RCTs and requires further study before firm recommendations for clinical practice can be made.
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Affiliation(s)
- Josh Batterink
- Providence Health CarePharmacy1081 Burrard StreetVancouverBCCanadaV6Z 1Y6
| | - Tara A Cessford
- University of British ColumbiaInternal MedicineProvidence Health CareSt Paul's Hospital, 1081 Burrard StreetVancouverBCCanadaV6Z 1Y6
| | - Robert AI Taylor
- Providence Health CarePharmacy1081 Burrard StreetVancouverBCCanadaV6Z 1Y6
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Ringer M, Pulfrey S. Runner's new diet, his collapse, and his ECG: when a rapid ECG diagnosis can save the day. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:340-344. [PMID: 24733324 PMCID: PMC4046560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Hyperkalemia is common in patients with end-stage renal disease, and may result in serious electrocardiographic abnormalities. Dialysis is the definitive treatment of hyperkalemia in these patients. Intravenous calcium is used to stabilize the myocardium. Intravenous insulin and nebulized albuterol lower serum potassium acutely, by shifting it into the cells. Despite their widespread use, neither intravenous bicarbonate nor cation exchange resins are effective in lowering serum potassium acutely. Prevention of hyperkalemia currently rests largely upon dietary compliance and avoidance of medications that may promote hyperkalemia. Prolonged fasting may provoke hyperkalemia, which can be prevented by administration of intravenous dextrose.
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Affiliation(s)
- Nirupama Putcha
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Alfonzo AVM, Isles C, Geddes C, Deighan C. Potassium disorders—clinical spectrum and emergency management. Resuscitation 2006; 70:10-25. [PMID: 16600469 DOI: 10.1016/j.resuscitation.2005.11.002] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 10/28/2005] [Accepted: 11/03/2005] [Indexed: 11/22/2022]
Abstract
Potassium disorders are common and may precipitate cardiac arrhythmias or cardiopulmonary arrest. They are an anticipated complication in patients with renal failure, but may also occur in patients with no previous history of renal disease. They have a broad clinical spectrum of presentation and this paper will highlight the life-threatening arrhythmias associated with both hyperkalaemia and hypokalaemia. Although the medical literature to date has provided a foundation for the therapeutic options available, this has not translated into consistent medical practice. Treatment algorithms have undoubtedly been useful in the management of other medical emergencies such as cardiac arrest and acute asthma. Hence, we have applied this strategy to the treatment of hyperkalaemia and hypokalaemia which may prove valuable in clinical practice.
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Olowu WA, Elusiyan JBE, Badejo SA, Adenowo OA. Acute renal failure in African children with Burkitt's lymphoma: a comparison of two treatment regimens. Pediatr Blood Cancer 2006; 46:446-53. [PMID: 16206217 DOI: 10.1002/pbc.20473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The outcome for patients presenting with acute renal failure and Burkitt lymphoma (BLARF) without dialysis is poor. This was a retrospective non-randomized comparative study designed to determine the outcome of two different treatment protocols. METHODS One group of patients (TPA) received oral allopurinol, intravenous (IV) cyclophosphamide, vincristine, methotrexate, furosemide, 8.4% sodium bicarbonate, and intrathecal (IT) methotrexate; the other (TPB) alternate day IV infusion of low dose cyclosphosphamide (125 mg/m(2) x 4 doses), IT methotrexate (Days 1 and 5) and aggressive pre-emptive anti-tumor lysis syndrome therapy including oral allopurinol and calcium lactate, IV calcium gluconate, salbutamol, insulin and infusions of furosemide, sodium bicarbonate and glucose. RESULTS Nine of 16 received TPA, 7 received TPB. Post chemotherapy anemia was more severe with TPA (P < 0.05). TPB patients received significantly more chemotherapy than those in TPA (P = 0.04). All 16 had tumor lysis syndrome (TLS). Six of nine patients with TPA died from this (three from other causes), two deaths in TPB were due to causes other than tumor lysis. Other evaluated outcome indices were similar in both groups. CONCLUSION Slow IV infusion of low dose cyclophosphamide given on alternate days in addition to pre-emptive anti-TLS measures (TPB) were associated with better outcome in BLARF patients compared to a high dose multiple chemotherapy regimen (TPA).
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Affiliation(s)
- Wasiu A Olowu
- Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
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Abstract
BACKGROUND Hyperkalaemia occurs in outpatients and in between 1% and 10% of hospitalised patients. When severe, consequences include arrhythmia and death. OBJECTIVES To review randomised evidence informing the emergency (i.e. acute, rather than chronic) management of hyperkalaemia SEARCH STRATEGY We searched MEDLINE (1966-2003), EMBASE (1980-2003), The Cochrane Library (issue 4, 2003), and SciSearch using the text words hyperkal* or hyperpotass* (* indicates truncation). We also searched selected journals and abstracts of meetings. The reference lists of recent review articles, textbooks, and relevant papers were reviewed for additional potentially relevant titles. SELECTION CRITERIA All selection was performed in duplicate. Articles were considered relevant if they were randomised, quasi-randomised or cross-over randomised studies of pharmacological or other interventions to treat non-neonatal humans with hyperkalaemia, reporting on clinically-important outcomes, or serum potassium levels within the first six hours of administration. DATA COLLECTION AND ANALYSIS All data extraction was performed in duplicate. We extracted quality information, and details of the patient population, intervention, baseline and follow-up potassium values. We extracted information about arrhythmias, mortality and adverse effects. Where possible, meta-analysis was performed using random effects models. MAIN RESULTS None of the studies of clinically-relevant hyperkalaemia reported mortality or cardiac arrhythmias. Reports focussed on serum potassium levels. Many studies were small, and not all intervention groups had sufficient data for meta-analysis to be performed. On the basis of small studies, inhaled beta-agonists, nebulised beta-agonists, and intravenous (IV) insulin-and-glucose were all effective, and the combination of nebulised beta agonists with IV insulin-and-glucose was more effective than either alone. Dialysis is effective. Results were equivocal for IV bicarbonate. K-absorbing resin was not effective by four hours, and longer follow up data on this intervention were not available from RCTs. AUTHORS' CONCLUSIONS Nebulised or inhaled salbutamol, or IV insulin-and-glucose are the first-line therapies for the management of emergency hyperkalaemia that are best supported by the evidence. Their combination may be more effective than either alone, and should be considered when hyperkalaemia is severe. When arrhythmias are present, a wealth of anecdotal and animal data suggests that IV calcium is effective in treating arrhythmia. Further studies of the optimal use of combination treatments and of the adverse effects of treatments are needed.
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Affiliation(s)
- Brian A Mahoney
- Family Medicine/Anesthesia1882 Berrywood CrKingstonONCanadaK7P 3G8
| | - Willard AD Smith
- Northeastern Ontario Medical Education CorporationGP AnesthesiaNOFM 935 Ramsey Lake RdSudburyONCanadaP3E 2C6
| | - Dorothy Lo
- McMaster UniversityDepartment of Internal Medicine1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Keith Tsoi
- McMaster UniversityDepartment of Internal Medicine1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Marcello Tonelli
- University of CalgaryDepartment of Medicine7th Floor, TRW Building3280 Hospital Drive NWCalgaryABCanadaT2N 4Z6
| | - Catherine Clase
- McMaster UniversityDepartment of MedicineSt Joseph's HealthcareSuite 708, 25 Charlton Ave EastHamiltonONCanadaL8N 1Y2
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15
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Filippi L, Cecchi A, Dani C, Bertini G, Pezzati M, Rubaltelli FF. Hypernatraemia induced by sodium polystyrene sulphonate (Kayexalate) in two extremely low birth weight newborns. Paediatr Anaesth 2004; 14:271-5. [PMID: 14996269 DOI: 10.1046/j.1460-9592.2003.01210.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hyperkalaemia is a life-threatening electrolyte disorder that can occur in the first week of life in almost 50% of preterm infants with a birth weight less than 1000 g [extremely low birth weight (ELBW)]. Serum potassium values higher than 7 mmol x l-1 are associated with cardiac arrhythmias and an increased incidence of intraventricular haemorrhage and periventricular leucomalacia. Therapeutic options to treat this dangerous imbalance comprise calcium gluconate, insulin plus glucose, albuterol/salbutamol inhalation. Administration of cation-exchange resin such as sodium polystyrene sulphonate (Kayexalate) is effective in lowering plasma potassium, although complications following oral or rectal administration are reported in newborns. We describe two ELBW infants affected by hyperkalaemia, treated with Kayexalate, who developed serious hypernatraemia, that has never been reported before in preterm infants.
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Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Department of Critical Care Medicine, University Careggi Hospital, Florence, Italy.
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16
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17
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Bockenkamp B, Vyas H. Understanding and managing acute fluid and electrolyte disturbances. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/j.cupe.2003.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Abstract
Acute renal failure may be caused by a failure of renal perfusion (pre-renal failure), damage to the renal parenchyma (intrinsic renal failure) or obstruction of the urinary tract (post-renal failure). Most cases of intrinsic renal failure in the newborn are due to asphyxia, often in combination with sepsis and nephrotoxic drugs. Persistent elevation of the plasma creatinine concentration above 132.5 micromol/l (1.5mg/dl) is widely accepted as a diagnostic criterion. Oliguria or anuria may occur but is not always present. Post-renal failure is diagnosed by renal ultrasonography and is treated by relief of the obstruction. Pre-renal and post-renal failure can be distinguished by an analysis of urinary indices, especially the fractional sodium excretion, and by the response to fluid replacement. The conservative management of intrinsic renal failure includes careful attention to fluid balance, maintenance of adequate nutrition and prevention or correction of hyperkalemia, acidosis and hyperphosphatemia. Severe cases may require dialysis: peritoneal dialysis is used in most cases, but extracorporeal methods, including intermittent hemodialysis, hemofiltration and hemodiafiltration, are possible. Congenital chronic renal failure, usually caused by renal dysplasia with or without obstruction, presents in a manner similar to that of acute renal failure, with a progressive deterioration of plasma biochemical values. Dialysis is rarely necessary in the newborn period. The conservative management of chronic renal failure is similar to that of acute renal failure, with particular emphasis on nutrition, control of acidosis and the prevention of renal osteodystrophy by the use of dietary phosphate binders and vitamin D analogs.
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Affiliation(s)
- George B Haycock
- Academic Department of Paediatrics, Guy's, King's and St Thomas' Hospitals School of Medicine, King's College, University of London, London, UK.
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19
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Pancu D, LaFlamme M, Evans E, Reed J. Levalbuterol is as effective as racemic albuterol in lowering serum potassium. J Emerg Med 2003; 25:13-6. [PMID: 12865102 DOI: 10.1016/s0736-4679(03)00133-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Albuterol is an effective treatment for hyperkalemia through beta-adrenergic induction of potassium (K+) uptake. Levalbuterol, the R-enantiomer of racemic albuterol, is used for the treatment of asthma and 0.63 mg of levalbuterol has the same therapeutic efficacy as 2.5 mg of albuterol but with a decreased adverse effects profile. We hypothesized that levalbuterol can reduce serum K+ levels similarly to albuterol when used in equipotent doses. In a randomized, double blind, placebo-controlled prospective study, we compared the K+-lowering effects of nebulized saline and equipotent bronchodilatory doses of albuterol (10 mg) and levalbuterol (2.5 mg) in healthy adult volunteers. Nine subjects entered each of the three study groups. Serum K+ was measured at baseline, at 30 min (immediately after treatment), at 60 min, and at 90 min. All adverse effects were recorded. The three groups had similar baseline K+ values. Immediately after nebulization, only levalbuterol showed a significant decrease in potassium level (p = 0.024). At 30 and 60 min after treatment, both albuterol and levalbuterol groups had significantly lower K+ values compared to placebo. No significant difference occurred between the albuterol and levalbuterol groups. Levalbuterol caused fewer reported adverse effects compared to albuterol.
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Affiliation(s)
- Diana Pancu
- Department of Emergency Medicine, Bellevue-New York University Hospital Medical Center, 27th and First Avenue, New York, NY 10016, USA
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20
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Singh BS, Sadiq HF, Noguchi A, Keenan WJ. Efficacy of albuterol inhalation in treatment of hyperkalemia in premature neonates. J Pediatr 2002; 141:16-20. [PMID: 12091845 DOI: 10.1067/mpd.2002.125229] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy of inhaled albuterol for treatment of hyperkalemia in premature neonates by conducting a prospective, randomized placebo-controlled and double-blinded clinical trial. STUDY DESIGN Neonates <2000 g receiving mechanical ventilation with central serum potassium > or =6.0 mmol/L (6.0 mEq/L), were randomly assigned to treatment or placebo groups. Albuterol (400 microg) or saline was given by nebulization. The dose was repeated every 2 hours until the potassium level fell below 5 mmol/L (maximum 12 doses) or there were signs of toxicity. RESULTS Nineteen patients completed the study (8 in the albuterol and 11 in the saline group). Serum potassium levels declined rapidly in the first 4 hours in the albuterol group, from 7.06 +/- 0.23 mmol/L to 6.34 +/- 0.24 mmol/L (P =.003) versus no significant change in the saline group (6.88 +/- 0.18 mmol/L to 6.85 +/- 0.24 mmol/L; P =.87). At 8 hours, the fall continued to be greater in the albuterol group versus the saline group (5.93 +/- 0.3 mmol/L and 6.35 +/- 0.22 mmol/L, respectively; P =.04). CONCLUSION Albuterol inhalation may be useful in rapidly lowering serum potassium levels in premature neonates.
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Affiliation(s)
- Bindya S Singh
- Division of Neonatology, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, Missouri, USA
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21
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Abstract
This review evaluates the various causes and management of acute renal failure (ARF) in children. ARF is defined as an abrupt decline in the renal regulation of water, electrolytes and acid-base balance, and continues to be an important factor contributing to the morbidity and mortality of critically ill infants and children. The common causes of ARF in children include acute tubular necrosis secondary to various causes (including congestive heart failure and sepsis), haemolytic uremic syndrome, and glomerulonephritis and urinary tract obstruction. Ischaemia, toxins (including drugs) as well as primary parenchymal disease, have to be considered and ARF can also be a complication of systemic disease. The basic principles of management are avoidance of life-threatening complications, maintenance of fluid and electrolyte balance, and nutritional support. Only a few patients require specific management of the underlying disorder, although it is important to diagnose these conditions. Knowledge about the use of drugs for the prevention of ARF is scarce. Mannitol, low-dose dopamine, calcium channel antagonists, atrial natriuretic peptide and albumin have been evaluated and, where possible, meta-analyses are cited. Mannitol treatment appears to be warranted prophylactically after paediatric renal transplantation. Albumin infusion can reverse prerenal ARF in children with nephritic syndrome. For treatment of the complications of hyperkalaemia and volume overload, salbutamol, insulin and glucose infusion and diuretics such as furosemide and sodium bicarbonate, are discussed. All of the major dialysis modalities (peritoneal dialysis, haemodialysis and continuous haemofiltration) can be used to provide equivalent solute clearance and ultrafiltration. The indication for, and the choice of the modality depend on the patient requirements and on local resources, and should involve the care of a paediatric nephrologist. Peritoneal dialysis requires minimal equipment and infrastructure, is easy to perform and remains the favoured modality of renal replacement therapy in children. However, continuous haemofiltration is an excellent alternative to peritoneal dialysis in patients with ARF and severe fluid overload. Dialysis remains the most important tool to bridge the time needed for recovery of renal function. There is increasing evidence that more intense use of dialysis may improve the overall prognosis.
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Affiliation(s)
- G Filler
- Department of Paediatrics, Division of Paediatric Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
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22
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Cumberbatch GL, Hampton TJ. Hyperkalaemic paralysis--a bizarre presentation of renal failure. J Accid Emerg Med 1999; 16:230-2. [PMID: 10353058 PMCID: PMC1343346 DOI: 10.1136/emj.16.3.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Paralysis due to hyperkalaemia is rare and the diagnosis may be overlooked in the first instance. However it is rapidly reversible and so long as electro-cardiography and serum potassium measurement are urgently done in all patients presenting with paralysis, it will not be missed. A case of hyperkalaemic paralysis is described and a review of the emergency management discussed.
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23
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Mandelberg A, Krupnik Z, Houri S, Smetana S, Gilad E, Matas Z, Priel IE. Salbutamol metered-dose inhaler with spacer for hyperkalemia: how fast? How safe? Chest 1999; 115:617-22. [PMID: 10084465 DOI: 10.1378/chest.115.3.617] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To determine the efficacy of inhaled salbutamol (rapidly delivered, using a metered-dose inhaler with a spacer device [MDI-S]) in lowering the serum potassium levels in patients with hyperkalemia. DESIGN A randomized, double-blind, placebo-controlled trial. PATIENTS Seventeen chronic renal failure patients referred to the Nephrology Unit between October 1, 1997 and March 31, 1998 for hemodialysis were randomized. INTERVENTION AND RESULTS Group 1 received salbutamol followed by a placebo. Group 2 received a placebo followed by salbutamol. Each patient inhaled 1,200 microg salbutamol or a placebo through an MDI-S within 2 min. Blood samples were obtained repeatedly before inhalation and after 1, 3, 5, 10, and 60 min. The pulse rate and blood pressure were repeatedly measured. Insulin levels were examined in a subset of patients (n = 10) before, and 1 and 5 min following inhalation. Salbutamol's known side effects, palpitation, tachycardia tremor, and headache, were recorded. Potassium levels rose after 1 min following the completion of treatment and then decreased steadily thereafter. A rise of > or = 0.1 mEq/L was seen in 10 of 17 patients (59%) during the treatment period and there was no change (0%) seen during the placebo period (p < 0.0001). Within 3 min after inhalation of salbutamol, potassium levels declined as a function of time. Potassium levels in those patients taking the placebo did not change as a function of time (p < 0.001). The difference between the placebo and the salbutamol-treated periods reached significance after 5 min (p < 0.05). The serum glucose levels rose following inhalation of salbutamol, with a significant rise after 3 min. The heart rate rose significantly within the first 5 min following inhalation. Serum insulin levels remained unchanged 1 min after inhalation; however, after 5 min, a significant elevation was detected. CONCLUSION Salbutamol inhalation of 1,200 microg, using an MDI-S, has a relatively rapid onset of action that induces a consistent reduction in serum potassium levels, starting 3 to 5 min following delivery. Unexpectedly, a paradoxical elevation was detected in serum potassium levels in the first minutes following inhalation. This effect, although minor (0.15 mEq/L above baseline), may cast some doubt on the role of salbutamol inhalation as the first treatment for excessive hyperkalemia.
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Affiliation(s)
- A Mandelberg
- Department of Pulmonary Medicine, The Edith Wolfson Medical Center, Hulon, Israel.
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24
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Abstract
Hypokalemia is a common side effect in adult asthmatic patients on beta 2 adrenergic therapy. There is limited information in regard to hypokalemia and its relation to the clinical responses following administration of beta 2 agonist therapy in children with asthma. We observed that salbutamol inhalation significantly improved asthmatic symptoms as demonstrated by increases in peak expiratory flow (PEF: 122.37+/-75.38 vs. 152.59+/-80.29; P < 0.001) and venous oxygen tension (Pv,O2: 33.24+/-4.95 vs. 58.16+/-2.31; P < 0.001), and decreases in respiratory rate (RR: 36.39+/-3.78 vs. 28.62+/-3.12; P< 0.01), clinical scores (CS: 3.59+/-1.28 vs. 1.59+/-0.71), and venous PCO2 tensions (Pv,CO2: 40.84+/-2.67 vs. 34.75+/-2.31; P < 0.001). Salbutamol-induced hypokalemia was correlated with a decrease in RR, and an increase of Pv,O2 and PEF. These findings suggest that the same mechanism is involved in eliciting hypokalemia and bronchodilatation.
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Affiliation(s)
- C H Hung
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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25
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Abstract
OBJECTIVE To describe an experience from a developing country of newborn renal disease particularly those without advanced neonatal care. METHODOLOGY Prospective evaluation from a referral hospital, North-East of Nigeria between 1 July 1990 and 30 June 1994. Babies admitted for any morbidities who were diagnosed as being in acute renal failure (ARF) during the study period (non-oliguric inclusive). Onset of ARF; day on which oliguria or anuria detected, or serum urea first exceeded 10 mmol/L. Urine output quantitated from carefully bagged urine and suprapubic bladder aspiration, and venous blood regularly obtained for serum electrolytes, urea and creatinine. Fractional excretion of sodium (FE(Na)) and renal failure index (RFI) were determined on some babies. RESULTS Forty-three neonates (M:F; 3.3:1) with ARF, the majority (27) of whom were out-born, and 14, 26 and three were preterm, full-term and post term, respectively. Encountered incidence was 3.9/1000 live births with a high prevalence rate; 34.5/1000 admissions. A significantly greater incidence was seen in the latter half of study; 10.7 vs 53.7/1000, P < 0.05. Early ARF occurrence (aged; 0-5 days) in 33 (77%) of babies. The aetiology was comprised of perinatal asphyxia, sepsis, obstructive uropathy and miscellaneous in 53.4%, 32.6%, 9.3% and 4.7%, respectively. Twenty-two (51.2%) deaths occurred; however, the exact causes were indeterminable. Fractional excretion of sodium (FE(Na)) and renal failure index (RFI) were of < 1.75% and < or = 2.0, respectively, significantly differentiated sepsis (intrinsic) from perinatal asphyxial (pre-renal) ARF; P < 0.01. No case of persistent renal failure occurred. CONCLUSION Our FE(Na) value (although less than reported in previous literature from affluent societies) remained sensitive (along with RFI) in differentiating aetiological group of ARF. Our data and medical management outcome, despite absence of level-III care, support the need for good resuscitation, careful monitoring and constant re-evaluation. The effect of salbutamol on hyperkalaemia is emphasized.
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Affiliation(s)
- A Airede
- Department of Paediatrics, University of Maiduguri Teaching Hospital, Borno State, Nigeria
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26
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Olowu WA. Hypertension and acute renal failure in Nigerian children with Burkitt's lymphoma: report of three cases and review. ANNALS OF TROPICAL PAEDIATRICS 1997; 17:169-74. [PMID: 9230982 DOI: 10.1080/02724936.1997.11747882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- W A Olowu
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
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27
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Abstract
This article discusses the causes and nature of hypokalemia and hyperkalemia. Diagnosis, testing, drug administration, and general management are outlined in detail.
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Affiliation(s)
- A K Mandal
- Section of Nephrology, Department of Veterans Affairs Medical Center, Dayton, Ohio, USA
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28
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Singhi SC, Jayashree K, Sarkar B. Hypokalaemia following nebulized salbutamol in children with acute attack of bronchial asthma. J Paediatr Child Health 1996; 32:495-7. [PMID: 9007778 DOI: 10.1111/j.1440-1754.1996.tb00961.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether use of nebulized salbutamol therapy for treatment of an acute attack of asthma in children is associated with hypokalaemia and if so what is its frequency, severity and effect on recovery. METHODOLOGY Forty-six children, aged 10 months to 12 years (mean 7.9 +/- 1.5 years) with acute attack of bronchial asthma, treated initially with three doses of nebulized salbutamol 0.15-0.3 mg/kg, every 30 min participated in the study. Blood for serum potassium was obtained at the beginning and after three doses of nebulized salbutamol therapy, before administering other drugs. RESULTS The mean +/- SD serum potassium level decreased marginally from 3.9 +/- 0.5 mEq/L to 3.7 +/- 0.5 mEq/L (P < 0.05). A decrease in serum potassium concentration was noted in 26 (56.5%) and hypokalaemia (serum potassium < 3.5 mg/L) in 17 (39%) patients. It was more frequent in patients who had received oral salbutamol for the preceding 7 days. The average time taken for recovery was longer in patients who had hypokalaemia than those who had normal serum potassium concentration (8.6 +/- 2.7 h vs 6.5 +/- 2.7 h; P < 0.005). CONCLUSIONS Hypokalaemia may occur in about one-third of patients treated with three doses of nebulized salbutamol therapy, especially those on prior oral salbutamol therapy. The monitoring of serum potassium concentration may be warranted in such patients.
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Affiliation(s)
- S C Singhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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29
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Kemper MJ, Harps E, Hellwege HH, Müller-Wiefel DE. Effective treatment of acute hyperkalaemia in childhood by short-term infusion of salbutamol. Eur J Pediatr 1996; 155:495-7. [PMID: 8789768 DOI: 10.1007/bf01955188] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED Hyperkalaemia is a life-threatening emergency and infusion of glucose with insulin has so far been regarded as the standard treatment of choice. Recently the beta-2 stimulatory drug salbutamol has been shown to be an effective agent to treat hyperkalaemia by inducing a shift of potassium into the intracellular compartment. We treated 15 children aged 0.1-14 (mean 5.2) years suffering from acute hyperkalaemia (mean level 6.6 +/- 0.54, range 5.9-7.7 mmol/l) with a single infusion of salbutamol (5 micrograms/kg over 15 min). Serum potassium concentrations decreased significantly within 30 min to levels of 5.74 +/- 0.53 and 4.92 +/- 0.53 mmol/l after 120 min (P < 0.001, respectively). No side-effects occurred other than a light increase in heart rate in 3 patients. CONCLUSION A single intravenous infusion of salbutamol at a dose of 5 micrograms/kg is a highly effective treatment for hyperkalaemia with minimal clinical side-effects. The effect lasts for at least 120 min and may reverse hyperkalaemia in some patients without further interventions so that salbutamol seems justified as the first choice treatment for this condition in childhood.
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Affiliation(s)
- M J Kemper
- Division of Paediatric Nephrology, University Children's Hospital, Hamburg, Germany
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31
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Coulthard MG, Vernon B. Managing acute renal failure in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 1995; 73:F187-92. [PMID: 8535880 PMCID: PMC2528481 DOI: 10.1136/fn.73.3.f187] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M G Coulthard
- Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle upon Tyne
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32
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Abstract
Although only 2% of the body potassium is present in the extracellular space, its concentration is finely regulated by the internal balance, or distribution of potassium between the intracellular and extracellular compartments, and by the external balance, or difference between intake and output of potassium. Internal balance is modulated by a host of factors, including insulin, epinephrine, extracellular pH and plasma tonicity. Potassium output from the body is mainly determined by renal excretion. Renal secretion of potassium takes place predominantly in the principal cells of late distal and cortical collecting tubules, by a process involving the accumulation of potassium in the cell by the activity of the basolateral Na+,K(+)-ATPase and its exit through luminal conductive channels. The factors regulating renal potassium secretion are potassium intake, rate of tubular fluid flow, distal sodium delivery, acid-base status and aldosterone. Hypokalaemia may result from a low potassium intake, excessive gastrointestinal, cutaneous or renal losses and altered body distribution. Aetiological diagnosis and therapy are best accomplished when the acid-base status is assessed at the same time. Before establishing the diagnosis of hyperkalaemia, spurious hyperkalaemia due to haemolysis or release of potassium from cells during clot retraction (pseudohyperkalaemia) should be ruled out. Hyperkalaemia may result from exogenous or endogenous loading, decreased renal output and altered body distribution. Acute hyperkalaemia represents an emergency situation which requires immediate therapy.
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Affiliation(s)
- J Rodríguez-Soriano
- Department of Paediatrics, Hospital de Cruces and Basque University School of Medicine, Bilbao, Spain
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