HYPERKALEMIA

Definition

Hyperkalemia is the medical term used to describe a potassium level that is higher than normal in the
blood. Potassium is a chemical that is critical to the function of nerve and muscle cells, including those
in the heart. Like hypokalemia, hyperkalemia is often caused by iatrogenic (or treatment-induced)
causes. Although it is less common than hypokalemia, it is usually more dangerous, because cardiac
arrest is more frequently associated with high serum potassium levels.

Pathophysiology

The predisposing factors for hyperkalemia include the age, presence of untreated renal failure,
pseudohypokalemia (a variation of hyperkalemia) and hypoaldosteronism or Addison’s Disease. The
precipitating factors include iatrogenic causes and medications. The increase level of serum potassium
has three major causes: decreased renal excretion of potassium, rapid administration of potassium,
and movement of potassium form the ICF compartment to the ECF compartment. The increase level
of serum potassium makes the smooth muscle contractions too weak to coordinate. The rapid
administration of potassium, such as medications, have been identified as a probable contributing
factor in more than 60% of hyperkalemic episodes. It causes disturbance in cardiac conduction,
decreasing cardiac depolarization then rapid repolarization, causing ventricular fibrillation and cardiac
arrest. In acidosis, potassium moves out of the cells into the ECF as hydrogen ions enter the cells to
buffer the pH of the ECF. An elevated ECF potassium level then occurs.

Clinical Manifestations

The increase in serum potassium levels causes manifestations in the cardiovascular, gastrointestinal
and lymphatic systems. For the cardiovascular system, hypotension, cardiac arrest, convulsions and
severe weakness progressing may occur. For the gastrointestinal system, nausea, intermittent
intestinal colic and diarrhea may occur. For the lymphatic system, severe infections may occur. Other
manifestations such as burns and crushing injuries are also to be expected when there is hyperkalemia.

Diagnostic Studies

Lab Tests are done to check the level of potassium in the blood and urine. Blood is withdrawn from a
vein, like other blood tests. The potassium concentration of the blood is determined. If hyperkalemia
is suspected, an ECG/EKG is often performed. This is done to check for problems with the heart
rhythm. It records the heart’s electrical activity and may show changes typical for hyperkalemia in
moderate to severe cases.

Medical Management

In non-acute situations, restriction of dietary potassium and potassium-containing medications may

correct the imbalance. For example, eliminating the use of potassium-containing salt substitutes in a
patient who is taking a potassium-conserving diuretic may be all that is needed to deal with milk
hyperkalemia. Prevention of serious hyperkalemia by the administration, either orally or by retention
enema, of cation exchange resins may be necessary in patient with renal impairment. If serum
potassium levels are dangerously elevated, it may be necessary to administer IV calcium gluconate. IV
administration of sodium bicarbonate may be necessary to alkalinize the plasma, causing a temporary
shift of potassium into the cells, and furnishing sodium to antagonize the cardiac effects of potassium
(Vacca, 2008).
Nursing Diagnosis

1. Risk for Imbalanced Fluid Volume related to Electrolyte and Acid-Base Imbalance
2. Decreased Cardiac Output related to alteration in Heart Rate, Rhythm, and Conduction
3. Diarrhea related to Increased Secretion of Potassium

Nursing Intervention

1. Observe for signs of muscle weakness and dysrhythmias.

- High potassium levels in the blood can cause heart problems. Bradycardia can
progress to cardiac fibrillation and arrest.
2. Observe for presence of paresthesias and GI symptoms.
- The client is usually conscious and alert, however, muscular paresthesia,
weakness, and flaccid paralysis may occur.
3. Serum potassium levels, as well as BUN, creatinine, glucose, and arterial blood gas values, are
monitored for patients at risk for developing hyperkalemia.
- Evaluate therapy needs and effectiveness.
4. Encourage patient to avoid potassium-rich foods such as most fruits and vegetables, legumes,
whole-grain bread, meat, milk, eggs, coffee, tea, and cocoa.
- Early identification and intervention can avoid complications. Prevention of
hyperkalemia can be managed with diet, supplements, and other medications.

References

https://www.mayoclinic.org/symptoms/hyperkalemia/basics/definition/sym-
20050776#:~:text=Hyperkalemia%20is%20the%20medical%20term,including%20those%20in%20you
r%20heart.
https://www.medicinenet.com/hyperkalemia/article.htm
https://www.uspharmacist.com/article/updated-treatment-options-in-the-management-of-
hyperkalemia#:~:text=Other%20treatment%20options%20for%20hyperkalemia,agents%20are%20al
so%20in%20development.
https://www.webmd.com/a-to-z-guides/what-does-potassium-do-body#1
 HYPERKALEMIA

(High Potassium Levels)

PREDISPOSING FACTORS
PRECIPITATING FACTORS
- Age
- Renal failure - Iatrogenic
- Pseudohypokalemia - Medications
- Addison’s Disease

Serum Potassium Increase level of Risk for Imbalanced

level higher than 5 serum potassium Fluid Volume related
mEq/L to Electrolyte and
Movement of
Adic-Base Imbalance
potassium from the
Rapid administration Decreased renal ICF compartment to
of potassium excretion of the ECF
potassium compartment

Disturbance in Smooth muscle Hydrogen ions enter

cardiac conduction contractions may be the cells to buffer
ECG shows too weak to the pH of the ECF
flattening of P waves coordinate
and widening of QRS
Burns, crushing
complex
injuries, severe
Decreased Cardiac Nausea, intermittent Elevated ECF infections
Depolarization intestinal colic, potassium level
Decreased Cardiac diarrhea
Output related to
Alteration in Heart Diarrhea related to
Rate, Rhythm, and Increased Secretion
Conduction of Potassium
 ECG shows
shortening of the QT
interval and narrow
Rapid Repolarization - Restriction of
and peak T waves
dietary potassium
- Observe for signs
and potassium-
of muscle
containing meds
weakness and
Hypotension, cardiac - Adminstriation of
dysrhythmias
arrest, convulsions cation exchange
Ventricular - Observe for
and severe resins (orally or
Fibrillation presence of
weakness retention enema)
paresthesias and GI
progressing - Administer IV
symptoms
calcium gluconate
- Monitor blood
or sodium
pressure
Cardiac Arrest bicarbonate

LEGENDS:

Predisposing Factors

Precipitating Factors

Disease Process

Clinical Manifestations

Diagnostic Test Results

Nursing Diagnosis

Medical Management

Nursing Interventions