![]() ![]() Hyperkalemia is variably defined as potassium >5.5 mM or >5.0 mM, depending on the source.There should always be a high suspicion for hyperkalemia in any bradycardic patient, especially if there are other EKG findings to suggest hyperkalemia.Hyperkalemia can manifest with bradycardia (often in the context of other drugs that slow down the AV node).Profound widening of QRS complex and peaked T-waves mimics a sine wave.Useful clues: Compared to ventricular tachycardia, T-waves can be sharper than would be usual and heart rate is often slower than would be typical.If patient is tachycardic, this will look like ventricular tachycardia. QRS wave widens and P-waves may disappear.Often this is the most notable finding on the EKG (may be visible on bedside monitor as well).In an unstable patient, it may be reasonable to give IV calcium based on patterns #2-4 below while awaiting a potassium level. The following patterns are highly suggestive of hyperkalemia.Dextrose: If glucose 7 mM) can occur without obvious EKG changes.5 units insulin as an intravenous bolus.IV calcium (1 gram of calcium chloride, or 3 grams of calcium gluconate).Target euvolemia with a bicarbonate of ~24-28 mM.⚠️ Do not give normal saline, because normal saline will increase the potassium. ![]() If bicarbonate is normal/high, use lactated Ringers or plasmalyte.If bicarbonate is low, resuscitate with isotonic bicarbonate (D5W with 150 mEq/L sodium bicarbonate, typically three 50-mEq amps of bicarb in a liter of D5W).Treatment for severe hyperkalemia (>6.5 mM): volume resuscitation if hypovolemic ![]()
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