Disorders of Potassium Balance

Authors: Andrew Parfitt, Emma Townsend / Editors: Steve Fordham / Reviewer: Chris Gray, William Gibbs / Codes: O7 / Published: 24/07/2023

This session looks at disorders of potassium metabolism, and in particular the presentation of hypokalaemia and hyperkalaemia in the emergency department (ED). It also covers the investigation and management of these conditions.

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By the end of this session you will be able to:

  • Identify spurious hyperkalaemia
  • Evaluate serum potassium levels in the context of total body potassium
  • Establish whether hypokalaemia or hyperkalaemia is present
  • Outline the initial treatment of hypokalaemia and hyperkalaemia
  • Recognise the ECG abnormalities that may be associated with these conditions

References

  1. Schaefer TJ & Wolford RW. Disorders of Potassium. Emerg Med Clin North Am 23(3): 723-47, 2005.
  2. Gennari FJ. Disorders of potassium homeostasis. Hypokalemia and hyperkalemia. Crit Care Clin. 2002 Apr;18(2):273-88, vi.
  3. Truhl A, Deakin CD, Soar J, Khalifa GE, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015 Oct;95:148-201.
  4. Ettinger PO, Regan TJ, Oldewurtel HA. Hyperkalemia, cardiac conduction, and the electrocardiogram: a review. Am Heart J. 1974 Sep;88(3):360-71.
  5. Montague BT, Ouellette JR, Buller GK. Retrospective review of the frequency of ECG changes in hyperkalemia. Clin J Am Soc Nephrol. 2008 Mar;3(2):324-30.
  6. OMalley CM, et al. A randomized, double-blind comparison of lactated Ringers solution and 0.9% NaCl during renal transplantation. Anesth Analg 100(5):1518-24, 2005.
  7. Khajavi MR, Etezadi F, et al. Effects of normal saline vs. lactated ringer’s during renal transplantation. Ren Fail. 2008;30(5):535-9.
  8. Weisberg LS. Management of severe hyperkalemia. Crit Care Med 36(12):3246-51, 2008.
  9. Batterink J, Cessford TA, Taylor RAI. Pharmacological interventions for the acute management of hyperkalaemia in adults. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD010344.
  10. Alfonzo AV, Isles C, Geddes C, Deighan C. Potassium disorders–clinical spectrum and emergency management. Resuscitation. 2006 Jul;70(1):10-25.
  11. Abuelo JG. Treatment of Severe Hyperkalemia: Confronting 4 Fallacies. Kidney Int Rep. 2017 Oct 7;3(1):47-55. doi: 10.1016/j.ekir.2017.10.001.
  12. Buttner R, Burs E. Hyperkalaemia. Life in the FastLane, 2022. [Accessed 21 June 2023].
  13. Rezaie S. ECG Changes of Hyperkalemia. REBELEM, 2014. [Accessed 21 June 2023].

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