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S. Faubel and J. Topf19 Hyperkalemia
19
19 Hyperkalemia
540
The Fluid, Electrolyte and Acid-Base Companion
Introduction
Hyperkalemia is an elevated plasma potassiumconcentration.
Hyperkalemia is defined as a plasma potassium concentration greaterthan 5 mEq/L. Hyperkalemia is a common complication of renal failure.In the absence of renal failure, hyperkalemia is relatively uncommon be-cause the kidneys have the ability to excrete large amounts of potassium.Recognizing hyperkalemia in patients with normal renal function is impor-tant because it is a flag for systemic disorders that might otherwise go un-noticed.
Hyperkalemia is defined as a plasma potassium greater than______ mEq/L.In the absence of _______ ________, hyperkalemia is uncommon.Normally, the kidney can effectively __________ a lot of potassi-um in order to prevent ____________.aaafiverenal failureexcretehyperkalemia
Na
+
Cl
–
HCO
3 –
K
+
Sometimes, it is useful to convert from milligrams to milliequivalents of potassium.This wasreviewed in Chapter 1,
Moles and Water
. To convert milligrams to milliequivalents, dividethe milligrams by the molecular weight. For example, one serving of orange juice (8 oz)contains 450 mg of potassium; 450 mg
÷
39 is equal to 11.3 mEq of potassium.
Na
22.989
Mg
24.305
19
K
39.098
Na
22.989
Mg
24.305
19Potassium
K
39.098
20Calcium
Ca
40.08
541
S. Faubel and J. Topf19 Hyperkalemia
1 2
Potassium loads are handled in a two-step process consisting of intracel-lular compensation followed by renal correction.
Compensation.
A potassium load is buffered by the movement of potas-sium into cells. This immediate defense against hyperkalemia is stimulatedby:•catecholamines•insulin•increased plasma potassium
Correction.
Hyperkalemia is corrected by the excretion of excess potas-sium by the kidney. This long-term defense against hyperkalemia is stimu-lated by:•elevated plasma potassium•aldosterone•increased flow through the distal tubulesThe kidney excretes the majority of a potassium load within hours of in-gestion.
The compensation for a K
+
load is the shift of plasma potassiuminto ______________ .The molecular weight of potassium is ______. A bunch of bananas contains about 3 grams of potassium. Howmany milliequivalents is this?extracellularcells3977 mEq
Overview:
The body has a two-step defense against hyperkale-mia: intracellular buffering followed by renal excretion.
K
+
K
+
K
+
K
+
K
+
K
+
K
+
K
+
K
+
K
+
Renal excretion of potassium cor-rects hyperkalemia.Movement of potassium into cells com-pensates for hyperkalemia.
compensationcorrection
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