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A. The normal upper limit of plasma K is 5-5.5 mEq/L, with a mean K level of
4.3.
the form of vegetables and meats. The kidney is the primary organ for
A. Chronic Renal Failure. The kidney is able to excrete the normal dietary
intake of potassium until the glomerular filtration rate falls below 10 cc/minute
or until urine output falls below 1 L/day. Renal failure is advanced before
hyperkalemia occurs.
hyperkalemia, and the renal tubular acidosis caused by these conditions may
worsen hyperkalemia.
hyperkalemia.
3. Acute K overload may result from infusion from the dependent portion of
hyperkalemia.
increase, the initial ECG change is tall peaked T waves. The QT interval is
normal or diminished.
B. As K levels rise further, the PR interval becomes prolonged, then the P wave
amplitude decreases. The QRS complex widens into a sine wave pattern,
with subsequent cardiac standstill.
C. At serum K levels of >7 mEq/L, muscle weakness may lead to a flaccid
paralysis that spares cranial nerve function. Sensory abnormalities, impaired
speech, and respiratory arrest may follow.
V. Pseudohyperkalemia
A. The serum K level should be repeat tested to rule out laboratory error. If
significant thrombocytosis or leukocytosis is present, a plasma potassium
level should be determined.
B. Measure 24 hour urine output, urinary K excretion, blood urea nitrogen, and
A. If urinary K excretion is low and urine output is in the oliguric range and
cause. Prerenal azotemia resulting from volume depletion must be ruled out
because the hyperkalemia will respond to volume restoration.
B. When urinary K excretion is low, yet blood urea nitrogen and creatinine levels
are not elevated and urine volume is at least 1 L daily and renal sodium
Low plasma renin and aldosterone levels, will confirm the diagnosis of
1. Calcium Chloride
level.
2. Insulin
a. If the only ECG abnormalities are peaked T waves and the serum level
in renal failure. §