Penanganan Hiperkalemia
Management of HyperkalemiaAristo2015DEFINITIONS
Hyperkalemia is defined as serum potassium greater than 5.5
mEq/LIt is further categorized as:Mild = serum potassium 5.5 - 6
mEq/LModerate = serum potassium 6.1 - 6.9 mEq/LSevere= serum
potassium > 6.9 mEq/LBAckgroundPotassium is intracellular cation
98% and only 2% in the extracellular fluid The Na+/K+- Pump 3Na+
out : 2K+ in60-75% K is reabsorbed in the proximal tubule by
diffusionRenal maintain K homeostasis until GFR < 15 ml/min/1.73
m2.Lehnhar, Kemper, Pathogenesis, diagnosis and management of
hyperkalemia, Pediatr Nephrol (2011) 26:377384
Etiologi Excessive potassium intakeImpaired elimination of
potassium from bodyIncreased shift of potassium to extracellular
spaceCLINICAL EFFECTS OF HYPERKALEMIA
Neuromuscular : Weakness, Paresthesi, and Ascending
paralysis.
ECG changes :Tall TLoss of P WaveWidening QRS ComplexCardiac
arrthymias:Sinus bradycardia, Sinus arrest, Ventricular
fibrillation, Asystole.
Goal TherapyStabilize cardiomycyte cell membran to prevent
aritmiaIncrease shift K into the cellEnhance eliminating K from
bodyEvaluate potential toxicities and initiate ECG monitoringSevere
hyperkalemia/shows ECG changes, ICU immediately.Ca-Gluconate 10%
cardiac symptoms to stabilize membrane potentialCI:
digoxin-intoxication, hypercalcemic states.Increase K shift to
intracellular space
Insulin + dextrose 25 50 mgBeta-adrenergic agonists (salbutamol,
reproterol) decrease of 1.6- 1.7 mmol/l after 2 hSodium
bicarbonate, metabolic asidosis. Increase potassium excretion
Loop diuretics (furosemide)
Ion-exchange resins (Kayexalate)
Hemodialysis1 mEq in 60 s2 mEq in 180 sImmediately eliminate
sources of potassium intakeStop oral or parenteral potassium
supplements.Stop all drugs that might cause hyperkalemia.Diet avoid
potassium-rich foods especially in CKD
Management of Hyperkalemia
Mushiyakh, Dangaria, Qavi, et all, Treatment and pathogenesis of
acute hyperkalemia, Journal of Community Hospital Internal Medicine
Perspectives ,2011.Terima kasihManagement of hyperkalemia
