Electrolyte Management

METABOLIC ABNORMALITY

DEFINITION

MANAGEMENT

Hyperkalemia (Moderate and asymptomatic)

K between 6 – 7 mEq/L

• Restrict K intake.
• EKG and cardiac monitoring.
• If tolerating oral intake, administer potassium binder: sodium polystyrene sulfonate (kayexalate).

Hyperkalemia

(Severe and/or symptomatic)

K >7 mEq/L

Same as moderate +

Symptoms: severe muscle weakness, EKG changes with peaked T waves and/or widening of QRS complex.

• If EKG changes, administer Calcium gluconate to reduce cardiac muscle excitability and decrease the risk of dysrhythmia.
• (may be repeated after 5-10 minutes if EKG changes persist).
• To temporarily shift K intracellular: IV insulin and dextrose, albuterol.
• Optimize renal excretion (loop diuretics preferred)
• In rare cases when potassium sparing measures lead to symptomatic HYPOkalemia, can replace carefully with close monitoring and ensure UOP and kidney function are maintained.

Hyperphosphatemia

Moderate ≥ 6 mg/dL

• Excess phosphate binds to calcium and results in secondary hypocalcemia and Ca-P deposition in the body.
• Restrict phosphorus intake
• If tolerating oral intake, administer phosphate binder: sevelamer, aluminum hydroxide (avoid the later with renal dysfunction)
• If these do not work, may need loop diuretics for hyperfiltration or dialysis.

Hypocalcemia

Ca ≤7.0 mg/dL or

iCal ≤0.80 mmol/L

Symptoms: tetany, seizures, dysrhythmias

• ASYMPTOMATIC hypocalcemia should NOT be treated. Calcium Phosphate precipitation can contribute to AKI. Calcium levels often normalize when Phos and UA normalize.
• If symptomatic, calcium gluconate via slow infusion with monitoring of EKG.

Uremia

Elevated BUN with altered mental status.

• Fluid and electrolyte management.
• Uric acid and phosphorus management.
• Adjust medications for renal impairment.
• Dialysis if refractory to above.