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Etiology 1. Increase K intake Potassem supplements (oral- IV) Food rich in K (e.g. banana ) Stores blood transfusion Drugs contain K 2. Decreased K excretion – renal failure DM ( most common) Hypertension Polycystic kidney disease Other disease (SLE , Amyloidosis , IgA nephrophathy , infection .. Ect ) 3. extracellular DKA acidosis Digitalis toxicity Acute tissue breakdown : - Hemolysis -Tumor lysis syndrome - Rhabdomyolysis Investigations Confirm elevated serum K ECG Glucose level –CBC BUN- creatinin – eGFR – Cr clearance Urine K and osmolality ABG(Acidosis as in DKA or RF) Urine acid – phosphorus (tumor lysis syndrome) CK- urinary myoglobin ( rhabdomyolysis ) Serum sortisol and aldosterone level treatment In mild chronic cases: K<6.5 mEq /l or K <6 mEq /l and no other symptoms or sign or ECG changes Treat the underlying cause of increased K Control DM ,HTN , ect . 3.Cation exchange resins Sodium polystyrene sulfonate ( Resinokaten powder) Dose :15 g up to 4 times daily 15g = 4 level teaspoons Don’t use in emergency :slow action Contraindicated in constipation or other motility intestinal disorders (rare but dangerous side effect intestinal necrosis ) Not emergency case (Mild ) Patiromer ( veltassa ) Initial dose : 8.4g PO/day may be increased up to 25.2g/day Don’t use in emergency: slow action Could be used if the patient can stop ACEIs or ARBs as in HF Sodium zrconium cyclosilicate ( lokelma ) Dosing may range from 5g every other day to 15g q day); not to exceed 15g/day Don’t use in emergency: slow action Could be used if the patient can stop ACEIs or ARBs as in HF Moderate to severe cases K > 6.5 mEq /l 1. ICU-IV line – cardiac monitoring 2. Calcium gluconate 10ml of 10% over 2-3min (stabilization of cardiac cell membrane) -Action starts in few minutes and last for 30mins -Don’t use in digitalis toxicity and use Mg sulfate 2g IV over 5 mins 3. Insulin + glucose (10 U regular insulin +50 ml dextrose 50%) (intracellular shift of K ) -10 units actrabtis + 50% glucose -If dectrose 50% is not available add 10 units of regular insulin to 250 ml of dextrose -Action strat in 20 mins and lasts for 2-6 Hr 4. Nebulized salbutamol or albuterol 5. Loop diuretics and normal saline 0.9% (if normal kidney function) 6. NaHCO3(Sodium bicarbonate) 7. Dialysis in resistant cases