Nurses Guide to Hyperkalemia

• Establish a better understanding of hyperkalemia. 
• Identify causes of hyperkalemia.  
• Understand the vital role that nurses play in the treatment of hyperkalemia. 

Knowledge of Hyperkalemia 

Hyperkalemia is a condition in which the serum potassium level exceeds the normal limits, greater than 5 mEq/L. The normal serum potassium levels range from 3.5 to 5 mEq/L. 

Hyperkalemia can be classified as mild, moderate, and severe, depending on the serum potassium levels.  

• Mild hyperkalemia is from 5 to 6 mEq/L 
• Moderate hyperkalemia is from 6.1 to 7 mEq/L 
• Severe hyperkalemia is 7 mEq/L and greater 

In around 10% of hospital admissions, the patients are diagnosed with hyperkalemia. It can occur due to reasons like: 

• Increased potassium intake 
• Reduction in potassium excretion 
• The shift of potassium out of the cells 
• Impaired renal function  
• Due to other treatments and medication intake that affect serum potassium levels  

Potassium plays an essential role in maintaining cardiac function. Therefore, high serum potassium levels have to be corrected soon. Sometimes, hyperkalemia is the first sign of cardiac arrest.  

Potassium is excreted by the kidneys. It acts as the major intracellular cation and balances sodium in the extracellular fluid (ECF) to maintain electroneutrality in the body. The normal ratio is approximately 40 mEq of potassium in 1 L urine. 

The body does not store potassium. Therefore, it needs to be replenished through daily dietary intake. The body can also exchange it for hydrogen when changes in the body’s pH call for a need for cation exchange- a situation that occurs in metabolic alkalosis or other alterations that lead to increased cellular uptake of potassium, including insulin excess and renal failure.  

What Causes Hyperkalemia? 

The causes of hyperkalemia can be: 

• Decreased potassium excretion includes oliguric renal failure  
• Use of potassium-sparing diuretics such as spironolactone 
• Multiple transfusions or transfusions of stored blood 
• A decrease in adrenal steroids 
• Intake of NSAIDs in large doses  
• Overuse of potassium supplements  
• Inappropriate intravenous (IV) administration of potassium 
• Excessive use of potassium-based salt substitutes 
• Digitalis toxicity  
• Use of beta-adrenergic blocker drugs and other drugs such as heparin, captopril, and lithium 
• Adrenocortical insufficiency 
• Hypoaldosteronism 
• The transcellular shift of potassium can occur from within the cells to the ECF, leading to hyperkalemia- a condition that occurs in tumor lysis syndrome, rhabdomyolysis, metabolic acidosis, and insulin deficiency with hyperglycemia. 

Nurse’s Role in the Treatment of Hyperkalemia  

The nurse plays a vital role in treating hyperkalemia, and it is essential to be aware of their importance. For a patient you suspect with hyperkalemia, remember the following points in mind during history taking. 

• Hyperkalemia can occur for various reasons, and a detailed medical history is essential to identify the root cause. It is vital to take into account the patient’s medication history. Therefore, a comprehensive medical history is crucial to determine the underlying cause of hyperkalemia.
• A detailed history helps rule out the exact cause. Take a complete history of the patient’s medications (especially the beta-adrenergic blocking drugs, potassium-sparing diuretics, and corticosteroids), dietary intake, treatments, and health conditions.  
• Hyperkalemia can cause gastric upset, such as nausea and diarrhea, due to the hyperactivity of the gastrointestinal muscles.  
• Patients with hyperkalemia often experience muscle weakness, if not corrected timely can lead to paralysis.  
• The patient may also report heart irregularities, postural hypotension, and dizziness.  

Physical Examination  

• The most common symptoms of hyperkalemia are nausea, fatigue, and muscle weakness. On the ECG, you may notice changes and heart sounds may reveal overall slowed heart rate with an irregular or extra beat.  
• The patient with hyperkalemia can also have paraesthesia of the face, feet, hands, and tongue. It can also lead to general anxiety and irritability with low urine output.  

Psychosocial  

Weakness and fatigue due to hyperkalemia can make the patient feel helpless and irritable. Moreover, if it occurs due to medication nonadherence, the patient considers themselves responsible for the condition.  

Planning And Nursing Implementations  

• If hyperkalemia is not severe, it can be managed by stopping the intake of potassium supplements or potassium-sparing diuretics causing hyperkalemia. However, in extreme conditions, pharmacological treatment is required.  
• Emergency management of hyperkalemia is three-fold with IV administration of calcium gluconate, glucose, and insulin and the excess potassium has to be removed through dialysis.  

Drugs Used to Treat Hyperkalemia  

• Calcium gluconate as electrolyte replacement therapy, given in doses of 10 mg of a 10% solution IV over 2 to 3 minutes. It works by decreasing membrane excitability. One dose lasts 30–60 min; another may be repeated after 5 to 10 minutes if no change in ECG occurs. 
• Insulin hormone, given as 10 to 20 units of regular insulin IV. It helps combat hyperkalemia by lowering serum potassium by enabling more potassium to enter the cell. 
• Glucose is given as 25 to 50g IV to protect the patient from the hypoglycemic effects of insulin.  
• Sodium polystyrene sulfonate is a cation exchange resin, given orally or through enema as 15 g/60 mL in 20 to 100 mL sorbitol to facilitate the passage of resin through the intestinal tract. It helps remove 0.5 to 1 mEq/L of potassium with each enema, but an equivalent amount of sodium is retained. It works by exchanging sodium for potassium in the gastrointestinal tract, leading to the elimination of potassium.  
• As an emergency measure, sodium bicarbonate delivered IV (one ampule of a 7.5% NaHCO3 solution) helps increase pH and causes potassium to shift into the cells. It is particularly effective in treating metabolic acidosis. 

Allow the patient to express their thoughts and concerns clearly to you. In teaching, involve family members and caretakers with the patient.  

Inform the patient to avoid consuming potassium-rich foods such as potatoes, beet greens, bananas, orange juice, dried fruit, coffee, tea, and chocolate. 

The Bottom Line

Treat hyperkalemia in a timely, as it can become a life-threatening condition. When a patient is diagnosed with it, figure out the underlying cause. 

Make the necessary medication changes required that are leading to potassium retention. Compel the patient to visit the emergency room if they experience any symptoms of hyperkalemia.  

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