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1


Extracellular K level


4.0 - 4.5 mEq/L

2


Total body K is regulated by


the kidneys

3


Increasing the extracellular K concerntration results in

4


Early effects of hyperkalemia


increase myocyte excitability by shifting the resting membrane potential to a less negative value and thus closer to threshold

5


When  moderate hyperkalemia occurs


myocyte depression occurs

6


At what mV dose calcium channels open


-40 to -45 mV during phase 0

7


The phase 2 plateau is cause by what


the movement of K out of the cell and Ca into the cell. temporarily off setting eachother, hence the plateau

8


During phase 3 what happens


the Ca channels close and the K channels continue to release K out of the cell.  Hence the doward slope of the the curve to a more negative state.

9

Signs seen on an EKG of hyperkalemia


ST segment depression

Peaked T waves

shortening of the QT interval

10


Earliest sign of hyperkalemia on the EKG


Peaked T waves

11


Peaked T waves

K greater then 5.5 mEq/L

Only shows on 22% EKGs

12


K greater then 6.5 mEq/L


widening QRS complex and prolonged PR interval

13


8-9 mEq/L


SA node may stimulate the ventricles without atrial activity

14


10 mEq/L


SA node conduction no longer occurs

Junctional pacer takes over causeing accelerated junctional rhythm

15


> 10 mEq/L


widening of the QRS to become a sine wave and blends with the T wave.

U FUCKED Vfib and Asystole

16


3 Ways  to Treat Hyperkalemia


Membrane stabilization

Promote k influx into the Cell

Promote K Removal from the body

17


Initial Tx for hyperkalemia


Ca infusion to antagonize the effects of hyperkalemia at the cellular level

Changes the resting membrane potential to less negative decreasing the excitability of the cell

 

18


Ca effect can be seen how quickly


1-3 min

19


Ca effects las how long


30-60 min

20


which is the prefered calcium of choice IV gluconate or chloride


gluconate

10% solution given 10ml

or

100 mg

21


calcium chloride is how many times stonger then calcuim gluconate


3X

22


Typically how do you promote K influx into the cell


D50 and Insulin

effects are seen within 10 - 20 min

Decreases the K by 0.6 - 1 mEq/L

23


The quickest K removal is done how

dialysis

not the most fesible though

24


Other ways to get K out of the Body

Ion exchange resin with sorbitol via the gut, orally or rectally

decreases the K by 1 mEq/L in 24 hours