Hyperkalemia is an abnormally high level of potassium in the blood. It is rare in people with normal kidney function but can develop in those with renal insufficiency or failure. Risk factors include decreased renal function, low urine output, and rapid IV potassium infusion. Symptoms include cardiac abnormalities, muscle weakness, and nausea. Treatment focuses on reducing potassium levels through methods like calcium administration, insulin therapy, or dialysis in severe cases. Nurses monitor potassium levels, urine output, EKG changes, and symptoms to guide treatment and prevent dangerous complications like dysrhythmias.

1. HYPERKALEMIA

2. Hyperkalemia is an elevated potassium
level over 5 mEq/L. Hyperkalemia is
rarein patints with normal kidney function
but may develop in patients with renal
insufficiency or renal failure.
INCIDENCE:-
9-10% of potassium is excreted in the
urine, patients with severe traumatic
injuries- when potassium has intracellular

3. Spaces because of direct cellular injury (eg-
burns) develop hyperkalemia. The
presence of shock in these patients
compounds the problem because of low
circulating vascular fluids and dimnished
kidney function.
RISK FACTORS:-
- Insufficient renal function
- Decreased urinary output

4. - Rapid or excessive infusion of IV fluids
with potassium should be infused by
intravenous pumps.
Prevention of hyperkalemia is
essential because a rapid elevation of
serum potassium could cause cardiac
arrest. IV infusion of fluids with potassium
chloride for patients with limited renal
functionand low urine output should be

5. Carefully monitored and given very slowly
and not at all. Solutions containing
potassium should be infused by
intravenous pumps. Urinary output should
be assessed hourly when the patient is
recieving potassium supplement.
PATHOPHYSIOLOGY:-
- Disturbance in cardiac conduction

6. Especially through the purkinje fibers and
atrioventricular node, which may lead to
ectopic beats, prolonged diastole.
- Increase in pacemaker and ectopic foci
excitability .
- Cardiac arrest results with severe
potassium elevation.
- Increased smooth muscle contraction,
incraesed peristalsis.

7. - Increased neuromuscular irritability of
skeletal muscles to become weak owing to
a depolarization block in the muscle.
- Usually due to pre-existing renal
dysfunction, limits potassium excretion in
the urine.
- Hyperkalemia is present.
- Oliguria or anuria causes an accumulation
of potassium and other solutes, thus

8. Increasing the osmolality of body fluids.
- Oliguria or anuria causes an elevation of
creatine and urea nitrogen in intravascular
fluids.
CLINICAL MANIFESTATIONS:-
1) Cardiovascular:-
- First tachycardia and then bradycardia
2) Electrocardiographic changes:- peaked,
narrow T-waves, wide QRS complex,

9. Depressed ST segment, widened PR
interval
- Ectopic beats
- Hypotension
- Weakened cardiac contraction
2) Gastrointestinal:-
- Nausea, explosive diarrhea, intestinal
colic, hyperactive bowel sounds
(especially over splenic flexure)

10. 3) Neuromuscular
- Paresthesia (tingling sensation)
- Muscle weakness and later flaccid muscle
paralysis, muscle cramps.
4) Renal:-
- Oliguria and late anuria
LABORATORY FINDINGS:-
- Serum potassium>5mEq/L

11. - Serum creatinine>1.5mEq/dL
- Blood Urea Nitrogen>25mg/dL
MEDICAL MANAGEMENT:-
Potassium elevation must be corrected
before levels become severe. When the
serum potassium level is 5 to 5.5 mEq/L,
restriction of dietary potassium intake
may be all that is needed. However, if the
potassium excess is due to metabolic

12. acidosis, correcting the acidosis with
sodium bicarbonate promotes potassium
uptake into the cells. Improving urine
output usually decreases the elevated
serum potassium level. Potassium wasting
diuretics can be used.
When hyperkalemia is severe,
immidiate actions are needed to avoid
severe cardiac disturbances. These

13. These measures may include-
1) Intravenous calcium gluconate infusions
to decrease antagonistic effect of
potassium excess on the myocardium.
2) Infusion of insulin and glucose or sodium
bicarbonate to promote potassium
uptake into the cells. These methods
usually provides temporary relief, and
repeating them may not help.

14. As hyperkalemia persists or
increases, a cation exchange resin such as
polystyrene sulfonate (Kayexalate) may
be given orally or rectally. This treatment
stimulates the exchange of potassium ion
for a sodium ion in the intestinal tract, the
potassium ion is then excreted in the
stool. Because Kayexalate can be
constipating, sorbitol may be combined

15. With Kayexalate to prevent constipation
and induce diarrhea. For rectal
administration, it is given as retention
enema. In marked renal failure, peritoneal
dialysis or hemodialysis may be needed.
NURSING MANAGEMENT:-
Assessment:-
Nursing assessment focuses on clinical
manifestations of and laboratory findings

16. Associated with hyperkalemia.
The serum potassium level must be
closely monitored with high risk patients
and patients who are recieving potassium
supplements. A serum potassium level
greater than 7 mEq/L result in cardiac
disturbances. If this is not corrected or
the level rises, acrdiac arrest can result.
The ECG strips need to be assessed for

17. Narrowed, peaked T waves, deprerssed ST
segment and widening of QRS and r
interval.
The flow rate of IV fluids with
potassium should be closely monitored. A
rapidly infused intravenous fluid with
potassium can cause hyperkalemia. The
potassium in intravenous fluid is irritating
to the vein and subcutaneous tissue.

18. The nurse should assess for phlebitis and
infilteration into subcutaneous tissies,
which can cause sloughing and tissue
necrosis.
Nursing diagnosis:- Hyperkalemia r/t renal
dysfunction, shock from traumatic injuries
or burns.
Expected outcomes:- The nurse will
monitor the patient for return of serum

19. potassium level to normal, presence of
adequate (30 ml/hr) urinary output,
absence of signs and symptoms of
neuromuscular changes, and apical pulse
rate within normal range and without
dysrrythmia.
Implementation:- The nurse should have a
high index of suspicion for those disorders
that may cause hyperkalemia.

20. Assessment of signs and symptoms of
hyperkalemia must be ongoing, and
changes should be reported immidiately.
Muscle weakness and flaccid muscle
paralysis are symptoms of more severe
hyperkalemia.
The urine output should be
closely monitored every 1 to 8 hours
depending on patients’ condition. Changes

21. Eg- Urine output of less than 25 ml/hour or
less than 60 ml/day should be reported
immidiately. Most of the body’s excess
potassium is excreted in urine.
Methods prescribed for
correction of hyperkalemia should be
closely monitored by the nurse. If the
patient is taking digitalis preperation and
potassium correction is too rapid,
hypokalemia may result. A hypokalemic

22. state could enhance the action of digitalis
and cause digitalis toxicity. Serum
potassium levels and signs and symptoms
of hyperkalemia and hypokalemia need to
be continually assessed.
Nursing diagnosis:- Potential for
dysrrythmia r/t hyperkalemia.
Planning:- The nurse will monitor for
dysrrythmias, assess electrocargraphic

23. Recordings and report changes that are
related to cardiopulmonary resuscitation
may be required but is seldom successful
with severe hypokalemia because the
heart muscle wil, respond. Insulin and
glucose may be required but is seldom
successful with severe hypokalemia
because the heart muscle will not
respond. Insulin and glucose may be

24. given to reduce potassium levels
temporarily. The patient should be
assessed for decreased cardiac output as
as a result of bradycardia. The chest
should be auscultated for crackles, the
urine monitored for a decreased output,
and the extremities assessed for
peripheral edema. The nurse needs to
report abnormal findings.

25. EVALUATION:-
The patients’ status should be evaluated
every hour if the patient has severe
hyperkalemia. Revisions in the plan of
care may be required.
PATIENT EDUCATION:-
The patient will need to closely adhere to
the diet low in potassium if the
hyperkalemia is a chronic problem (eg-

26. Renal failure). Knowledge of food
preperation is important because cooking
styles can affect potassium levels.

27. THANK YOU