Fifteen-minute consultation: Emergency management of children presenting with hyperkalaemia

Hyperkalaemia can lead to life-threatening cardiac arrhythmias. A good understanding of the physiological basis of management can help us rationalise treatment and reduce plasma potassium levels efficiently and effectively. Management focuses on avoidance of arrythmias, rapid intracellular movement of potassium and finally reduction of total body potassium. Fluid management in hyperkalaemia should be carefully considered, with balanced solutions providing theoretical benefits compared to 0.9% saline in certain situations.

Fluctuations in plasma potassium in patients on dialysis

Plasma potassium concentration is maintained in a narrow range to avoid deleterious electrophysiologic consequences of both abnormally low and high levels. This is achieved by redundant physiologic mechanisms, with the kidneys playing a central role in maintaining both short-term plasma potassium stability and long-term total body potassium balance. In patients with end-stage renal disease, the lack of kidney function reduces the body’s ability to maintain normal physiologic potassium balance. Routine thrice-weekly dialysis therapy achieves long-term total body potassium mass balance, but the intermittent nature of dialytic therapy can result in wide fluctuations in plasma potassium concentration and consequently contribute to an increased risk of arrhythmogenicity. Various dialytic and nondialytic interventions can reduce the magnitude of these fluctuations, but the impact of such interventions on clinical outcomes remains unclear.

Physiology and pathophysiology of potassium homeostasis

Total body potassium content and proper distribution of potassium across the cell membrane is of critical importance for normal cellular function. Potassium homeostasis is maintained by several different methods. In the kidney, total body potassium content is achieved by alterations in renal excretion of potassium in response to variations in intake. Insulin and beta-adrenergic tone play critical roles in maintaining the internal distribution of potassium under normal conditions. Despite homeostatic pathways designed to maintain potassium levels within the normal range, disorders of altered potassium homeostasis are common. The clinical approach to designing effective treatments relies on understanding the pathophysiology and regulatory influences which govern the internal distribution and external balance of potassium. Here we provide an overview of the key regulatory aspects of normal potassium physiology. This review is designed to provide an overview of potassium homeostasis as well as provide references of seminal papers to guide the reader into a more in depth discussion of the importance of potassium balance. This review is designed to be a resource for educators and well-informed clinicians who are teaching trainees about the importance of potassium balance.

Gambaran kadar kalium serum pada pasien penyakit ginjal kronik stadium 5 non dialisis di Manado

Potassium is the main intracellular ion in the body and plays a key role in maintaining cell function. Total body potassium distributed 98% in intracellular and 2% in extracellular fluid. A slight change in the distribution of these can cause hypokalemia or hyperkalemia. A healthy kidney has great capacity to maintain potassium homeostasis in the cace of excess potassium. The kidney is primarily responsible for maintaining total body potassium content by matching potassium intake with potassium excretion. This study aimed to obtain the profile of potassium serum in non dialysis CKD stage 5 patients in Manado. This was an obsevartional descriptive study. There were 35 blood samples obtained from patients in Nephrology-Hypertension Polyclinic and IRINA of Prof. Dr. R.D Kandou Hospital and Teling Adventist Hospital. There were 11 samples (31,4%) with hypokalemia consisted of 6 home-care patients (35.3%) and 5 hospital-care patients (27.8%), 15 samples (42.9%) were in normal range consisted of 8 home-care patients (47.1%) and 7 hospital-care patients (38.9%), and 9 samples (25.7%) with hyperkalemia consisted of 3 home-care patients (17.6%) and 6 hospital-care patients (33,3%) from total non-dialysis CKD stage 5 samples resulted from laboratory examination. Conclusion: In non dialysis CKD stage 5 patients in Manado, normokalemia was the most common found than hypokalemia and hyperkalemia. Keywords: potassium, chronic kidney disease stage 5, non dialysis. Abstrak: Kalium adalah ion intraseluler utama dalam tubuh dan berperan penting dalam menjaga fungsi sel. Kalium tubuh total terdistribusi 98% intrasel dan 2% ekstrasel. Sedikit saja terjadi perubahan dalam distribusi ini dapat menyebabkan hipokalemia atau hiperkalemia. Ginjal yang sehat memiliki kapasitas yang besar untuk mempertahankan homeostasis kalium dalam menghadapi kalium yang berlebih. Ginjal bertanggung jawab dalam menjaga kadar kalium tubuh total dengan mencocokkan asupan kalium dan ekskresi kalium. Penelitian ini bertujuan untuk mengetahui gambaran kadar kalium serum pada pasien PGK non dialisis stadium 5 di Manado. Jenis penelitian ini deskriptif obsevasional. Sampel darah diambil dari pasien di Poliklinik Nefrologi-Hipertensi dan IRINA Bagian Penyakit Dalam RSUP Prof. DR. R. D. Kandou Manado dan RS Advent Teling sebanyak 35 sampel. Hasil: penelitian mendapatkan 11 orang yang mengalami hipokalemia (31,4%) diantaranya 6 orang pasien rawat jalan (35,3%) dan 5 orang pasien rawat inap (27,8%); 15 orang dalam batas nilai normal (42,9%) diantaranya 8 orang pasien rawat jalan (47,1%) dan 7 orang pasien rawat inap (38,9%); serta 9 orang mengalami hiperkalemia (25,7%) diantaranya 3 orang pasien rawat jalan (17,6%) dan 6 orang pasien rawat inap (33,3%) dari jumlah total pasien terdiagnosis dokter PGK stadium 5 non dialisis yang didapatkan dari hasil pemeriksaan laboratorium. Simpulan: Pada pasien PGK non-dialisis stadium 5 di Manado, normokalemia yang paling sering ditemukan dibandingkan hiper dan hipokalemia.Kata kunci: kalium serum, penyakit ginjal kronik stadium 5, non dialisis