Treatment of hyperkalemia: something old, something new RH Sterns et al. Kidney International (2016)

Yuan Chieh Chang

Treatment of hyperkalemia: something old, something new Kidney International 2016 Confirming the Diagnosis

Pseudohyperkalemia

e04

Venipuncture (Clotting) repeated clenching

Platelet-induced (serum) Lymphocyte-induced (plasma) Shaken-lymphocyte

After exercise

Gas (Heparin)

Treatment of hyperkalemia: something old, something new Kidney International 2016

Insulin

Blood glucose is

Treatment of hyperkalemia: something old, something new Kidney International 2016

Insulin

GLUT4[Insuline]100 mU/ml Na-K-ATPase

RH Sterns et al.: Treatment of hyperkalemia

Treatment of hyperkalemia: something old, something new Kidney International 2016

Insulin

GLUT4[Insuline]100 mU/ml Na-K-ATPase

Treatment of hyperkalemia: something old, something new Kidney International 2016

Insulin

Glucose given as bolus...

Treatment of hyperkalemia: something old, something new Kidney International 2016

Insulin

Hypoglycemia?

1-3

Bolus Prolonged Insulin half-lifein CKD patient

01:00

Treatment of hyperkalemia: something old, something new Kidney International 2016

Insulin

Hypoglycemia?

Incidence depends more on the dose of glucose than on the dose of insulin

Treatment of hyperkalemia: something old, something new Kidney International 2016

Insulin

Whats the suggestion?(Profound)

70kg Loading dose 6 U Maintain dose : 20 U/h Glucose 60 g per hour

10% glucose 600 ml/h

Treatment of hyperkalemia: something old, something new Kidney International 2016Sodium Bicarbonate

Skeletal muscle

Na

Bicarbonate

Na

H+

increase [PH]

increase [Na]K

Na

ATPase

MechanismIncrease Urinary K excretion

Treatment of hyperkalemia: something old, something new Kidney International 2016Elimination of potassium

Potassium binderKalimate, Kayexalate

Based on data in Feig et al

Treatment of hyperkalemia: something old, something new Kidney International 2016Dialysis

Nephrol Dial Transplant. 1997;12:16291634