Source / episode info
- **Episode:**313
- **Title:**Divine Intervention Episode 313 – The Floridly HY Hyperkalemia Podcast (for Step 1-3) + 20 hour 2CK/3 course reminder.
- **Published:**2021-05-15
- Source:Episode page
One-liner
This episode provides a comprehensive review of hyperkalemia, detailing its diverse causes—including adrenal insufficiency, metabolic acidosis, and drug toxicities—and outlining the step-wise emergency management protocol for cardiac stabilization and potassium reduction.
High-yield summary
- Hyperkalemia Definition: Serum K+ > 5.0 mEq/L (Normal: 3.5–5.0 mEq/L). Symptoms are often delayed until levels reach 5.5–6.0 mEq/L.
- Primary Adrenal Insufficiency (Addison's): Leads to low aldosterone -> impaired Na+ reabsorption in the collecting duct -> failure to secrete K+ and H+ -> Hyperkalemia + Normal Anion Gap Metabolic Acidosis (Type 4 RTA).
- Hyperkalemic Causes: Include cell lysis (rhabdomyolysis, burns, NMS), renal failure, metabolic acidosis (H+ efflux causes K+ efflux), or drugs that inhibit the Na+/K+-ATPase pump (e.g., ACEi/ARBs, K+-sparing diuretics, calcineurin inhibitors).
- Hyperkalemia Management Protocol: 1) Membrane stabilization (Calcium Gluconate); 2) Intracellular shift (Insulin + Glucose); 3) Excretion (Kayexalate or Diuretics); 4) Definitive removal (Hemodialysis).
- EKG Progression: Peaked T-waves -> Wide QRS complex -> Sinusoidal pattern -> Cardiac arrest.
Learning objectives
- Identify the mechanisms leading to hyperkalemia (e.g., impaired excretion vs. cell lysis).
- Differentiate the electrolyte abnormalities seen in primary versus secondary adrenal insufficiency.
- Outline the step-wise emergency management protocol for severe hyperkalemia, including drug choices and rationale.
- Recognize common drugs that inhibit potassium excretion or promote K+ release (e.g., ACEi/ARBs, K+-sparing diuretics).
- Understand the pathophysiology of specific conditions like Hyperkalemic Periodic Paralysis.
Board exam buzzwords