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IM Basics

IM Basics

De: Eric Acker
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Resident physicians teach topics that are commonly encountered during internal medicine rotations. Hosts are Dr. Eric Acker and Dr. Tark. Other appearances by Dr. Michael Bass and other resident physicians. We attempt to distill topics into easy-to-listen-to episodes that will help a medical student or intern quickly learn the basics of a topic. We strive to provide real-world experiences grounded in evidence-based medical practices.

Eric Acker
Episodios
  • Managing Hyperkalemia in the Hospital: Recognizing, Reacting, and Responding
    Jun 6 2025

    In this episode of IM Basics, Dr. Eric Acker and Dr. Tark break down the essentials of recognizing and managing hyperkalemia, a potentially life-threatening electrolyte disturbance. They discuss common presentations—ranging from dialysis patients to those with tumor lysis syndrome—and highlight key decision points in diagnosis and management.

    Topics Covered:

    • Common presentations of hyperkalemia and when to suspect it even without classic symptoms.
    • ECG findings in hyperkalemia: from peaked T waves to sine waves.
    • When to act and how aggressively, based on potassium levels and clinical stability.
    • The three pillars of treatment:
      • Cardiac membrane stabilization with calcium gluconate.
      • Potassium shift therapies (e.g., insulin with dextrose, high-dose albuterol).
      • Potassium elimination (e.g., dialysis, Lokelma®, loop diuretics, or rarely, Kayexalate®).
    • A practical discussion on the timing of interventions—why and when to delay shifting before dialysis.
    • Tips on avoiding overtreatment, interpreting lab errors like pseudohyperkalemia, and reassessing post-intervention.

    Clinical Pearls:

    • Use calcium gluconate to stabilize membranes, not to lower potassium directly.
    • Watch for hyperkalemia in AKI, rhabdomyolysis, tumor lysis syndrome, and missed dialysis.
    • Lokelma® has high sodium content—consider alternatives like patiromer in volume-sensitive patients.
    • Always reassess potassium after treatment to guide further interventions.

    References & Citations:

    • Sterns RH. "Hyperkalemia." N Engl J Med. 2022;386(15):1426–1435. DOI: 10.1056/NEJMra2110952.
    • Montford JR, Linas S. "How dangerous is hyperkalemia?" J Am Soc Nephrol. 2017;28(11):3155–3165. DOI: 10.1681/ASN.2016121344.
    • Kayexalate safety concerns: Patel K, et al. "Sodium polystyrene sulfonate-induced colonic necrosis." Am J Med Sci.2012;343(2):155–157.
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    21 m
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