Renal
Key Electrolyte Emergencies
Renal

Key Electrolyte Emergencies

Hyperkalemia, hypocalcemia, lithium-induced DI.

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◆Hyperkalemia

  • •Tall peaked T waves → wide QRS → sine wave on ECG
  • •Step 1: IV calcium gluconate (stabilize myocardium)
  • •Step 2: insulin + glucose, albuterol (shift K into cells)
  • •Step 3: loop diuretic, kayexalate/patiromer, dialysis (remove K)
  • •Stop offending drugs (spironolactone, ACEi, NSAIDs)

◆Lithium-induced nephrogenic DI

  • •Chronic lithium causes nephrogenic DI
  • •Stop lithium if possible
  • •Amiloride blocks lithium uptake into collecting duct
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