Hyperkalemia

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  1. Significant quantities of K are released into the extracellular space in response to severe injury or surgical stress, acidosis, and the catabolic state
    1. NOTE: hypokalemia may occur in metabolic alkalosis because as hydrogen ions are reabsorbed by the renal tubular cells, K ion is excreted
  2. Signs of hyperkalemia are limited to cardiovascular and GI systems
    1. GI: nausea, vomiting, intermittent intestinal colic, and diarrhea
    2. cardiac: high peaked T waves, widened QRS complex, depressed ST segments (disappearance of T waves, heart block, and diastolic cardiac arrest may develop with increasing levels of K)
    3. NOTE: signs of hypokalemia are cardiac and muscular: weakness, hyporeflexia, and paralysis, prominent U waves on EKG
  3. Treatment: calcium as cardiac protectant, insulin and dextrose or bicarbonate to drive K intracellularly, exchange resins or loop diuretics to get rid of K
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