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1. HyperKalemia
Practical Approach
Mohammed Abdel Gawad
Nephrology Consultant - Alexandria - Egypt
MD Nephrology - Mansoura University - Egypt
European Specialty Examination in Nephrology (ESENeph)
NephroTube Founder/Admin
Member of ISN education SoMe team
Co-chair of AFRAN Web & Media Committee
drgawad@gmail.com
@Gawad_Nephro
NephroTube Webinar, 29-July-2021

2. To download the lecture contact me
drgawad@gmail.com
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4. Talk Outline
• Causes
• Clinical Presentation
• Treatment

5. Talk Outline
• Causes
• Clinical Presentation
• Treatment

6. Normal response to Hyperkalemia

7. General Causes of Hyperkalemia

8. General Causes of Hyperkalemia

17. Pseudo Hyperkalemia
This is commonly due to cellular
hemolysis during the blood draw

18. Pseudo Hyperkalemia
This is commonly due to cellular
hemolysis during the blood draw

19. General Causes of Hyperkalemia

20. General Causes of Hyperkalemia

23. Aldosteron

25. Handbook of Critical Care Nephrology. Chapter 21. 2021

28. Handbook of Critical Care Nephrology. Chapter 21. 2021

29. Talk Outline
• Causes
• Clinical Presentation
• Treatment

30. Talk Outline
• Causes
• Clinical Presentation
• Treatment

32. Muscle Weakness

33. Handbook of Critical Care Nephrology. Chapter 21. 2021
But interestingly, ECG changes do not correlate well
with the degree of hyperkalemia

34. Talk Outline
• Causes
• Clinical Presentation
• Treatment

35. Talk Outline
• Causes
• Clinical Presentation
• Treatment

36. Talk Outline
• Causes
• Clinical Presentation
• Treatment
1. Acute hyperkalemia
2. Chronic hyperkalemia

37. Talk Outline
• Causes
• Clinical Presentation
• Treatment
1. Acute hyperkalemia
2. Chronic hyperkalemia

38. Treatment Steps

39. Kidney International (2020) 97, 42–61

40. Kidney International (2020) 97, 42–61

41. Ca is cardioprotective
Ca does not decrease K

42. Ca is cardioprotective
Ca does not decrease K

43. Kidney International (2020) 97, 42–61

47. Kidney International (2020) 97, 42–61

48. Sodium bicarbonate

49. Sodium bicarbonate

50. Kidney International (2020) 97, 42–61

53. N Engl J Med 2015;

54. N Engl J Med 2015;

55. Kidney International (2020) 97, 42–61

57. First Treatment line
• With dialysis and, to some degree, gastrointestinal-binding
agents and diuretics, serum potassium levels rebound some 6
hours after treatment because of a lowered serum K and a
favorable electrochemical gradient for extracellular shifts of
potassium.
• In the case of ongoing hemolysis, cell death, or
rhabdomyolysis, these effects may require frequent repeated
IHD or perhaps transition to CKRT to maintain normokalemia.
Handbook of Critical Care Nephrology. Chapter 21. 2021

60. Talk Outline
• Causes
• Clinical Presentation
• Treatment
1. Acute hyperkalemia
2. Chronic hyperkalemia

61. Talk Outline
• Causes
• Clinical Presentation
• Treatment
1. Acute hyperkalemia
2. Chronic hyperkalemia

62. Kidney International (2020) 97, 42–61

63. Thank You