*Mineral Deficiencies - Electrolyte Disturbances, Genes, Diet and Disease Interface*

*3.1.2 Clinical presentation*

• Hyperkalemia can manifest with neuromuscular weakness, bradycardia and ventricular tachycardia/fibrillation. In practice however, most patients are asymptomatic [28].

EKG 1. EKG pattern showing changes in hyperkalemia.

then this will confirm the diagnosis.

severe hyperkalemia).

serum potassium.

**145**

• Whenever hyperkalemia is seen on labs, and EKG should be done. If EKG changes are present or patient is symptomatic consistent with hyperkalemia,

• In practice, most patients with hyperkalemia are asymptomatic (even with

• Potassium levels >6.5-7 (mmol/L) are more worrisome. Chronic hyperkalemia is better tolerated compared to acute which is more dangerous. Chronic hyperkalemia is seen in dialysis patients who are frequently hyperkalemic

• The acute management of hyperkalemia is the prevention or reversal of cardiac dysrhythmias. The primary goal of chronic treatment of hyperkalemia is to maintain serum potassium levels after acute treatment leads to reduction in

• Acute management of hyperkalemia [28, 30, 31]: See **Figure 5**.

Calcium lasts for 30-60 mins so it may need to be repeated.

• IV calcium gluconate is preferred over calcium chloride because calcium

• Regular insulin 10-20 units IV can be given with dextrose 25 g (when blood glucose <250 mg/dl). In patients with renal insufficiency, short acting insulin can be used. Insulin lasts for a few hours therefore may need to be re-dosed.

• 10-20 mg albuterol can be given in normal saline over 10 min with nebulizer.

chloride causes skin irritation and extravasation which can lead to skin necrosis or thrombophlebitis. Peripherally, 3 g IV calcium gluconate can be given over 10 min. For central access, 1 g over 10 min or slow IV push can be done.

*3.1.4 Treatment*

*Electrolytes in the ICU*

*DOI: http://dx.doi.org/10.5772/intechopen.96957*


## *3.1.3 EKG findings*

	- 1.Peaked T waves, best seen in the precordial leads
	- 2.Flattened P wave with prolonged PR interval
	- 3.Absent P wave
	- 4.Wide QRS and sine wave pattern

EKG 1. EKG pattern showing changes in hyperkalemia.
