What causes hyperkalemia in a patient who has experienced cardiac arrest (code)?

From the Guidelines

Hyperkalemia in patients who have experienced cardiac arrest is primarily caused by the release of intracellular potassium into the bloodstream due to widespread cell death, impaired kidney function, and metabolic acidosis, which can lead to life-threatening arrhythmias and require immediate treatment. The pathophysiology of hyperkalemia in this context involves the movement of potassium from the intracellular space to the extracellular space, which can be exacerbated by factors such as cell lysis, reduced blood flow, and acidosis 1. Some key points to consider in the management of hyperkalemia in patients post-cardiac arrest include:

• The importance of continuous cardiac monitoring to detect potential arrhythmias
• The need for immediate treatment to counteract the effects of hyperkalemia, such as administration of calcium gluconate, insulin with glucose, or sodium bicarbonate
• The consideration of underlying causes of hyperkalemia, such as renal impairment or certain medications, which may require specific interventions According to the most recent and highest quality study, the management of hyperkalemia should prioritize the stabilization of myocardial cell membranes, shifting potassium into cells, and removing potassium from the body 1. In terms of specific treatments, calcium chloride or calcium gluconate may be considered to stabilize myocardial cell membranes, while sodium bicarbonate may be used to shift potassium into cells 1. Overall, the management of hyperkalemia in patients who have experienced cardiac arrest requires a comprehensive approach that takes into account the underlying pathophysiology and the need for prompt and effective treatment to prevent life-threatening complications.

From the Research

Causes of Hyperkalemia

• Hyperkalemia can be caused by impaired renal excretion, transcellular shifts, or increased potassium intake 2, 3
• Kidney disease is a common cause of hyperkalemia, as the kidneys play a crucial role in regulating potassium levels in the body 2, 4
• Medication use, such as angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB), can also contribute to hyperkalemia 5
• Hyperglycemia and diabetic ketoacidosis (DKA) can lead to hyperkalemia, especially in patients with acute kidney injury (AKI) 6

Hyperkalemia in Cardiac Arrest

• Severe hyperkalemia can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction 2, 3
• Cardiac arrest due to hyperkalemia can occur in patients with DKA, especially if they have underlying kidney disease or are taking medications that increase potassium levels 6
• Hyperkalemia-induced cardiac arrest requires urgent treatment, including correction of potassium levels and management of underlying conditions 6, 3

Risk Factors for Hyperkalemia

• Patients with chronic renal insufficiency are at increased risk of developing hyperkalemia, especially when taking ACEi or ARB therapy 5
• Excessive potassium intake from diet, supplements, or drugs can also increase the risk of hyperkalemia 5
• Patients with DKA or hyperglycemia are at risk of developing hyperkalemia, especially if they have underlying kidney disease or are taking medications that increase potassium levels 6