Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis.
Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at firstname.lastname@example.org.
Join us at ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there!
Written and produced by: Matthew Watto, MD
Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD
Infographic: Matthew Watto MD
Edited by: Matthew Watto MD
Guest: Dr Joel Topf MD
- 00:00 Ad disclaimer, intro and guest bio
- 05:11 Guest one-liner and picks of the week —Peloton indoor cycle, “your local library”, The Nice Guys (film) by Shane Black, and Forgotten Hand (PS4 game)
- 11:17 ACP Internal Medicine Meeting 2019 details
- 12:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia
- 19:55 Hyperkalemia and the EKG
- 23:38 Threshold for treatment of hyperkalemia
- 27:20 Use of telemetry and the U-shaped curve for potassium and mortality
- 30:11 Choice of therapy for acute hyperkalemia
- 33:13 Albuterol for hyperkalemia
- 34:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring
- 39:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron
- 43:10 Fludrocortisone for hyperkalemia
- 45:05 Calcium for elevated potassium
- 48:43 SPS, potassium binding resin
- 52:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis
- 58:28 Sodium bicarbonate for acute and chronic hyperkalemia
- 61:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia
- 63:05 Threshold for admission; Diet and potassium
- 65:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods
- 68:45 Patiromer and sodium zirconium
- 71:51 Loop diuretics and empiric potassium supplementation
- 74:12 Can diet alone be used to treat HYPOkalemia?
- 75:26 Take home points
- 77:40 NephMadness is coming! March 2019
- 79:53 Outro
- 81:00 More Kidney Boy!