Hyperkalemia is a condition in which the potassium concentration in the plasma exceeds 5 mmol/l. It occurs as a result of the release of potassium from cells or the violation of excretion of potassium by the kidneys. Increase in potassium intake is rarely the only cause of hyperkalemia because adaptive mechanisms rapidly increase its excretion. Iatrogenic hyperkalemia occurs as a result of excessive parenteral administration of potassium, especially in patients with CRF.
Treatment depends on the degree of hyperkalemia and is determined by the concentration of potassium in the plasma, the presence of muscle weakness, changes in the ECG. Life-threatening hyperkalemia occurs when the potassium concentration in the plasma is increased by more than 7.5 mmol / l. In this case, pronounced muscle weakness, the disappearance of the P wave, expansion of the QRS complex, ventricular arrhythmias are observed.
Emergency care is indicated for severe hyperkalemia. Its goal is to recreate the normal resting potential, move potassium into cells and increase the excretion of potassium. Stop the flow of potassium from the outside, cancel preparations that violate its excretion. To reduce the excitability of the myocardium, calcium gluconate is administered, 10 ml of a 10% solution of IV in 2-3 minutes. Its action begins after a few minutes and lasts for 30-60 minutes. 5 minutes after the administration of calcium gluconate, the ECG changes are preserved, the drug is administered again at the same dose.