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Evidence-Based Management Of Potassium Disorders In The Emergency Department

November 2016

Abstract

Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed.

Key words: hypokalemia, hyperkalemia, potassium, magnesium, sodium polystyrene sulfonate, cation exchange resin, vomiting, diahrrhea, pseudohyperkalemia, Bartter syndrome, Gitelman syndrome, Andersen syndrome, aldosterone, periodic paralysis, insulin, dialysis, digoxin toxicity

Points:

  • About 80% of potassium excretion occurs in the kidney, 15% in the gastrointestinal system, and 5% from sweating.
  • Both hypokalemia and hyperkalemia can cause generalized fatigue, weakness, palpitations, and paralysis. Both are associated with increased risk for cardiac dysrhythmia that can be potentially fatal.
  • Obtain electrocardiogram (ECG) early if a potassium disorder is suspected. Hypokalemia is associated with a decrease in T-wave amplitude, prolonged PR, ST depression, T-wave inversion, U-wave formations, premature ventricular complexes, and atrial dysrhythmias. Hyperkalemia is associated with a prolonged QRS, flattened P-wave, PR depression, peaked T-wave, ectopic beats, and a sine wave.

Pearl:

  • SPS has not been proven to rapidly lower potassium levels in the acute setting and is associated with bowel necrosis.
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Last Modified: 04/26/2017
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