Hyperkalemia – From Dr. Farkas

Dr. Farkas is an assistant professor of Pulmonary and Critical Care Medicine and Dr. Farkas’ blog, PulmCrit, is always worth reviewing.

The chart below is from Management of severe hyperkalemia by Dr. Weisberg which Dr. Farkas recommends as the definitive review on hyperkalemia even though it is from 2008. There are a couple of things in the chart that no longer apply:

  1. Kayexalate doesn’t work.
  2. Dr. Farkas does not recommend saline for volume replacement and so I’m guessing he wouldn’t recommend hypertonic saline either.

Here’s Dr. Weisberg’s chart:

fig3

Today, I reviewed Dr. Farkas’ post Management of severe hyperkalemia in the post-Kayexalate era
March 15, 2015. Here is the summary from that post (But see the post for details on diuresis):

fig2

The following additional resources are from Dr. Farkas post above:

Additional resources
  • Podcast by Scott Weingart about treatment of severe hyperkalemia from 2010.
  • Review article by Weisberg regarding the management of severe hyperkalemia.   Although this article is now seven years old, it remains one of the best reviews out there.
  • Is Kayexalate effective?   This has been discussed in EMLyceumEMCritPrecious Bodily Fluids, and Kamel 2012.   There’s not much I can add to this discussion that hasn’t already been said, so if you’re interested in the Kayexalate issue please see these sources.
  • Prior post on pH-guided resuscitation describes the rationale for choosing different fluids during resuscitation in order to optimize the final acid-base status.
  • The effects of pH on renal handling of potassium is reviewed by Aronson 2011.   This is a very detailed article with lots of information about various potassium channels.
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