{"id":134,"date":"2020-08-13T16:05:40","date_gmt":"2020-08-13T16:05:40","guid":{"rendered":"http:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/?p=134"},"modified":"2020-08-19T11:37:18","modified_gmt":"2020-08-19T11:37:18","slug":"potassium-disorders","status":"publish","type":"post","link":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/potassium-disorders\/","title":{"rendered":"Potassium disorders"},"content":{"rendered":"<p><em>High and low potassium [K]. 20 mins.<\/em><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-content\/uploads\/sites\/2\/2020\/08\/Rob-Hunter-pic-188x300.jpg\" alt=\"\" class=\"alignright wp-image-166\" width=\"95\" height=\"152\" srcset=\"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-content\/uploads\/sites\/2\/2020\/08\/Rob-Hunter-pic-188x300.jpg 188w, https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-content\/uploads\/sites\/2\/2020\/08\/Rob-Hunter-pic.jpg 206w\" sizes=\"auto, (max-width: 95px) 100vw, 95px\" \/><\/p>\n<p><em>Rob Hunter, Consultant Nephrologist. Part of Renal in the <\/em><em>Edinburgh MBChB.<\/em><\/p>\n<h3><span style=\"color: #993300;\"><strong>Hyperkalaemia<\/strong><\/span><\/h3>\n<div style=\"width: 50%; float: right;\">\n<div style=\"width: 320px;\" class=\"wp-video\"><video class=\"wp-video-shortcode\" id=\"video-134-1\" width=\"320\" height=\"180\" loop preload=\"auto\" controls=\"controls\"><source type=\"video\/mp4\" src=\"http:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-content\/uploads\/sites\/2\/2020\/08\/CilienHyperkal.mp4?_=1\" \/><a href=\"http:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-content\/uploads\/sites\/2\/2020\/08\/CilienHyperkal.mp4\">http:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-content\/uploads\/sites\/2\/2020\/08\/CilienHyperkal.mp4<\/a><\/video><\/div>\n<\/div>\n<p><span>Severe hyperkalaemia is a medical emergency because it can cause life-threatening cardiac dysrhythmia. The commonest causes are acute or chronic kidney failure and drugs inhibiting the renin-angiotensin system. <em><br \/>\nHyperkalaemia gif by Edinburgh nephro alumnus <a href=\"https:\/\/artibiotics.com\/\">Dr Cilien Kearns<\/a>, <a href=\"https:\/\/twitter.com\/artibiotics\">@artibiotics<\/a><\/em><br \/>\n<\/span><\/p>\n<p><span>Management involves:<\/span><\/p>\n<ul>\n<li><span>stabilising cardiac conduction (with intravenous calcium salts) <\/span><\/li>\n<li><span>shifting potassium into cells (a temporary holding measure) <\/span><\/li>\n<li><span>enhancing potassium removal from the body (in the urine or using renal replacement therapy)<\/span><\/li>\n<\/ul>\n<p><span>For mild-to-moderate hyperkalaemia, it is important to weigh the benefits of potassium-lowering therapy against the iatrogenic risks. These risks include hypoglycaemia (after insulin therapy) and decompensated heart failure (after stopping RAS inhibitors).<\/span><\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" width=\"400\" height=\"285\" src=\"https:\/\/cdnapisec.kaltura.com\/p\/2010292\/sp\/201029200\/embedIframeJs\/uiconf_id\/32599141\/partner_id\/2010292?iframeembed=true&amp;playerId=kaltura_player&amp;entry_id=1_kt9dysxr&amp;flashvars[streamerType]=auto&amp;flashvars[localizationCode]=en&amp;flashvars[leadWithHTML5]=true&amp;flashvars[sideBarContainer.plugin]=true&amp;flashvars[sideBarContainer.position]=left&amp;flashvars[sideBarContainer.clickToClose]=true&amp;flashvars[chapters.plugin]=true&amp;flashvars[chapters.layout]=vertical&amp;flashvars[chapters.thumbnailRotator]=false&amp;flashvars[streamSelector.plugin]=true&amp;flashvars[EmbedPlayer.SpinnerTarget]=videoHolder&amp;flashvars[dualScreen.plugin]=true&amp;flashvars[Kaltura.addCrossoriginToIframe]=true&amp;&amp;wid=1_2qc2lpvr\" allowfullscreen=\"allowfullscreen\" frameborder=\"0\"><\/iframe><\/p>\n<p style=\"text-align: center;\">Hyperkalaemia video &#8211; 15 mins &#8211; covers &#8230;<\/p>\n<h3><span style=\"color: #993300;\"><strong>Core resources<\/strong><\/span><\/h3>\n<ul>\n<li><a href=\"https:\/\/renal.org\/wp-content\/uploads\/2020\/07\/APPENDIX-6-HYPERKALAEMIA-ALGORITHM-IN-HOSPITAL.pdf\">Hyperkalaemia in hospital<\/a>\u00a0 UK Renal Association 1-page algorithm 2020 (pdf, 2.9Mb)<\/li>\n<li><a href=\"https:\/\/renal.org\/wp-content\/uploads\/2020\/07\/APPENDIX-5-HYPERKALAEMIA-ALGORITHM-IN-COMMUNITY.pdf\">Hyperkalaemia in primary care<\/a>\u00a0 UK Renal Association 1-page algorithm 2020 (pdf 0.7Mb)<\/li>\n<li><a href=\"https:\/\/renal.org\/wp-content\/uploads\/2020\/07\/APPENDIX-7-HYPERKALAEMIA-CARDIAC-ARREST-ALGORITHM-2020.pdf\">Hyperkalaemic cardiac arrest<\/a>\u00a0 UK Renal Association 1-page algorithm 2020 (pdf 0.4 Mb)<\/li>\n<li><a href=\"http:\/\/edren.org\/ren\/education\/textbook\/fluids-and-electrolytes\/potassium\/\">Hyperkalaemia<\/a> (Edren textbook)<\/li>\n<li><a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/diet-in-renal-disease\/\">Low potassium diet for patients<\/a> (edren.org\/info)<\/li>\n<li>Case &#8230;<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3><span style=\"color: #993300;\"><strong>Hypokalaemia<\/strong><\/span><\/h3>\n<p><span>Hypokalaemia may be due to shift of potassium into cells, potassium loss in the urine or loss from the gut (vomiting or diarrhoea).<\/span><\/p>\n<ul>\n<li><span style=\"color: #993300;\"><strong>SHIFT INTO CELLS<\/strong><\/span>\n<ul>\n<li><span>catecholamines \/ beta-agonists <\/span><\/li>\n<li><span>insulin <\/span><\/li>\n<li><span>re-feeding syndrome <\/span><\/li>\n<li><span>hypokalaemic periodic paralysis<\/span><\/li>\n<li><span>metabolic alkalosis<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #993300;\"><strong>RENAL POTASSIUM LOSS<\/strong><\/span>\n<ul>\n<li><span>with metabolic alkalosis<\/span>\n<ul>\n<li><em><span>vomiting, diuretics, Gitelman, Bartter, mineralocorticoid XS, apparent mineralocorticoid XS<\/span><\/em><\/li>\n<\/ul>\n<\/li>\n<li><span>with metabolic acidosis<\/span>\n<ul>\n<li><em><span>renal tubular acidosis types I &amp; II<\/span><\/em><\/li>\n<li><em><span>DKA<\/span><\/em><\/li>\n<\/ul>\n<\/li>\n<li><span>with variable acid-base<\/span>\n<ul>\n<li><em><span>Mg-depletion<\/span><\/em><\/li>\n<li><em><span>non-reabsorbable anion (e.g.\u00a0high-dose IV penicillins)<\/span><\/em><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #993300;\"><strong>GASTROINTESTINAL POTASSIUM LOSS<\/strong><\/span>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span>with normal acid-base<\/span>\n<ul>\n<li><em><span>anorexia, tea &amp; toast diet, laxative abuse<\/span><\/em><\/li>\n<\/ul>\n<\/li>\n<li><span>with metabolic acidosis<\/span>\n<ul>\n<li><em><span>diarrhoea, villous adenoma<\/span><\/em><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span>The <span style=\"color: #993300;\"><strong>urine potassium concentration or 24 hr urine potassium<\/strong><\/span> excretion can be helpful in distinguishing between renal and extra-renal causes of hypokalaemia. Urine potassium is <\/span><\/p>\n<ul>\n<li><span>Low (&lt; 20 mM on a spot sample or &lt; 15 \u2013 20 mmoles per day) in extra-renal causes <\/span><\/li>\n<li><span>High (&gt; 20 mM on a spot sample or &gt; 15 \u2013 20 mmoles per day) in renal causes. <\/span><\/li>\n<\/ul>\n<p><span>One important thing to remember here is that vomiting actually promotes renal potassium loss, so expect a high urine potassium concentration after vomiting.<\/span><\/p>\n<h3><span style=\"color: #993300;\"><strong>Core resources<\/strong><\/span><\/h3>\n<ul>\n<li>Case &#8230;<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3><span style=\"color: #993300;\"><strong>Additional reading<\/strong><\/span><\/h3>\n<ul>\n<li><a href=\"http:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/electrolyte-disorders-general-approach\/\">Electrolyte disorders, a general approach<\/a> (this site)<\/li>\n<li>More advanced resources &#8230; coming<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>High and low potassium [K]. 20 mins. Rob Hunter, Consultant Nephrologist. Part of Renal in the Edinburgh MBChB. Hyperkalaemia Severe hyperkalaemia is a medical emergency because it can cause life-threatening cardiac dysrhythmia. The commonest causes are acute or chronic kidney failure and drugs inhibiting the renin-angiotensin system. Hyperkalaemia gif by [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":135,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14],"tags":[],"class_list":["post-134","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-physiology"],"_links":{"self":[{"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/posts\/134","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/comments?post=134"}],"version-history":[{"count":17,"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/posts\/134\/revisions"}],"predecessor-version":[{"id":291,"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/posts\/134\/revisions\/291"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/media\/135"}],"wp:attachment":[{"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/media?parent=134"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/categories?post=134"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medcal.mvm.ed.ac.uk\/wp\/renal\/wp-json\/wp\/v2\/tags?post=134"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}