hyperkalemia management
TRANSCRIPT
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Treatment of hyperkalemia: something old, something new RH Sterns et al. Kidney International (2016)
Yuan Chieh Chang
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Treatment of hyperkalemia: something old, something new Kidney International 2016 Confirming the Diagnosis
Pseudohyperkalemia
e04
Venipuncture (Clotting) repeated clenching
Platelet-induced (serum) Lymphocyte-induced (plasma) Shaken-lymphocyte
After exercise
Gas (Heparin)
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Treatment of hyperkalemia: something old, something new Kidney International 2016
Insulin
Blood glucose is
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Treatment of hyperkalemia: something old, something new Kidney International 2016
Insulin
GLUT4[Insuline]100 mU/ml Na-K-ATPase
RH Sterns et al.: Treatment of hyperkalemia
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Treatment of hyperkalemia: something old, something new Kidney International 2016
Insulin
GLUT4[Insuline]100 mU/ml Na-K-ATPase
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Treatment of hyperkalemia: something old, something new Kidney International 2016
Insulin
Glucose given as bolus...
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Treatment of hyperkalemia: something old, something new Kidney International 2016
Insulin
Hypoglycemia?
1-3
Bolus Prolonged Insulin half-lifein CKD patient
01:00
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Treatment of hyperkalemia: something old, something new Kidney International 2016
Insulin
Hypoglycemia?
Incidence depends more on the dose of glucose than on the dose of insulin
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Treatment of hyperkalemia: something old, something new Kidney International 2016
Insulin
Whats the suggestion?(Profound)
70kg Loading dose 6 U Maintain dose : 20 U/h Glucose 60 g per hour
10% glucose 600 ml/h
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Treatment of hyperkalemia: something old, something new Kidney International 2016Sodium Bicarbonate
Skeletal muscle
Na
Bicarbonate
Na
H+
increase [PH]
increase [Na]K
Na
ATPase
MechanismIncrease Urinary K excretion
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Treatment of hyperkalemia: something old, something new Kidney International 2016Elimination of potassium
Potassium binderKalimate, Kayexalate
Based on data in Feig et al
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Treatment of hyperkalemia: something old, something new Kidney International 2016Dialysis
Nephrol Dial Transplant. 1997;12:16291634