The role of calcium agents in hyperkalemia

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 07, 2024
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Change the excitability of autonomic cells to protect the heart. Hyperkalemia mainly affects the conduction of the heart and neuromuscular system. Typical clinical manifestations include severe bradycardia, atrioventricular block, and even sinus arrest. By using calcium agents to change the excitability of autonomic cells, we can protect the heart from the damage to the conduction system caused by hyperkalemia. This allows the potassium ions to move from outside the cell to inside the cell. While protecting the myocardium, it is also necessary to use some medications to lower blood potassium. If the blood potassium is particularly high, dialysis or continuous bedside blood filtration can be used to reduce the blood potassium to a normal range.

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What should be noted in the diet for hyperkalemia?

In cases of hyperkalemia, it is important to avoid eating foods high in potassium, such as corn, lettuce, carp, eel, lamb, beef, pork, as well as dates, bananas, and others. These foods are rich in potassium and should be consumed less or not at all. Additionally, a diet high in sugar and fat should be provided, or some intravenous nutrition may be used, to ensure sufficient caloric intake and prevent the release of potassium from metabolic breakdown, which could lead to an increase in blood potassium levels. Also, it is important to avoid certain medications high in potassium, such as traditional Chinese medicines. (Medication use should be under the guidance of a professional doctor.)

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What kind of urine occurs with hyperkalemia?

Primary hyperkalemia often coincides with metabolic acidosis, and in hyperkalemia-induced metabolic acidosis, paradoxical alkaline urine can occur. Once hyperkalemia occurs, it primarily affects the conduction of the heart and neuromuscular system. Typical clinical manifestations include severe bradycardia, atrioventricular conduction block, and even sinus arrest. In mild hyperkalemia, the electrocardiogram shows peaked T-waves; as potassium levels continue to rise, the PR interval prolongs, T-waves disappear, QRS complex widens, and ultimately, cardiac arrest occurs. Immediate treatment should be administered upon diagnosis to promote the excretion of potassium, maximizing the renal excretion capacity with diuretics. If drug-induced potassium excretion does not normalize levels and serum potassium exceeds 6.5 mmol/L, hemodialysis may be necessary. Additionally, some drugs can be used to shift potassium into the cells and protect cardiac function. (The use of any medication should be under the guidance of a doctor.)

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Intensive Care Unit
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The effects of hyperkalemia on the body

Hyperkalemia affects the body mainly in three aspects. Firstly, hyperkalemia impacts muscle tissues, clinically manifesting as symptoms such as muscle tremors. Secondly, the effect of hyperkalemia on the heart primarily manifests as decreased excitability, conductivity, and automaticity of the myocardium. It affects electrocardiograms, characterized by a depressed P wave, widened QS wave, reduced R wave, and elevated T wave. Thirdly, hyperkalemia affects acid-base balance; during hyperkalemia, potassium efflux from cells can lead to metabolic acidosis, resulting in alkaline urine.

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Written by Wei Shi Liang
Intensive Care Unit
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Clinical manifestations of hyperkalemia

The clinical manifestations of hyperkalemia mainly affect the cardiovascular system, often presenting with slowed heart rate and various arrhythmias. When the blood potassium level is between 6.6 and 8.0 mmol/L, a tent-shaped T-wave can be observed. Rapid increases in blood potassium can lead to ventricular tachycardia, and even ventricular fibrillation. A gradual increase in blood potassium can cause conduction blocks, and in severe cases, cardiac arrest. Sudden death in severe hyperkalemia is mainly due to ventricular fibrillation and cardiac arrest. The second aspect is symptoms related to the neuromuscular system. As the concentration of potassium ions in the extracellular fluid increases, the resting membrane potential drops, leading to muscle weakness and even paralysis, typically more pronounced in the lower limbs and extending upward along the trunk. In severe cases, some patients may experience difficulty in swallowing and breathing difficulties. Symptoms involving the central nervous system mainly include restlessness, confusion, and fainting.

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How should hyperkalemia be managed?

First, it is necessary to assess the severity of the hyperkalemia, whether it is mild, moderate, or severe. For mild hyperkalemia, it can be managed by taking oral diuretics or intravenous infusion of glucose with insulin, which can normalize the potassium level. In cases of severe hyperkalemia, where blood potassium exceeds 7.5 mmol/L, there is a risk of causing cardiac arrest. Emergency measures to promote potassium excretion are required, such as hemodialysis or peritoneal dialysis. It is also necessary to counteract the myocardial depressive effects of potassium, which can be managed with the injection of calcium gluconate, along with the intravenous infusion of hypertonic glucose and insulin. (The use of medications should be conducted under the guidance of a doctor.)