#537 Hyperkalemia and Hypokalemia

Yeah, no, you're making a lot of good points here, Matt.

Okay, cool.

Take-home points now?

Let's go.

So with, with hyperkalemia, so in patients, uh, and, and this episode, this was great because we did a previous hyperkalemia episode, like, in 2017 that was really focused on the acute management and, uh, and inpatient management.

So for all new interns that are listening to this, go find that old episode of hyperkalemia.

I'm sure you'll put a link into the show notes.

It really covered very different ground than this one.

This episode is much more focused on, hey, you're in clinic and you got a patient with mild hyperkalemia.

How do we think about it? And we talked about pseudohyperkalemia.

We talked about, uh, the lack of a relationship between dietary potassium, so don't spend a lot of time focusing on dietary advice.

That's really not gonna be helpful in these patients.

You're gonna really go off in the wrong direction, and that we're gonna focus on, we went through a, a good list of the medications that cause hyperkalemia and how to think about those medications.

And then, uh, in terms of management, uh, you know, don't sleep on your diuretics.

Use your loop diuretics.

U- L- Use your thiazide type, type diuretics.

Go ahead and treat their metabolic alkalosis with some sodium bicarb- excuse me.

Go ahead and treat their metabolic acidosis with some sodium bicarbonate.

Get that corrected.

That is also gonna help that.

And then make sure that our patients are not constipated.

When it came to hypokalemia, we talked about, uh, uh, whether that can be, uh, renal losses or extrarenal losses, and that, uh, we talked about, um, magnesium as being an important component in that and the proton pump inhibitors being involved there.

Before that, we also went in and we talked about the potassium switch, which I just need to talk about 'cause I think it's so darn cool, and this potassium switch is new physiology that we've discovered where it's, uh, the kidney just not leaving anything to chance, taking care of that potassium.

That increased potassium intake has a thiazide-like effect, which is gonna cause increased potassium excretion and increased sodium excretion, so you'll get some hypotensive effect, and that that was put into action in the SASS trial in rural China where we were able to reduce not only stroke but total mortality by giving patients additional potassium chloride.

And then lastly, we finished off in the dialysis unit where you should always finish off your dialysis in the d- uh, always finish off your rounds in the dialysis unit, and we talked about using some of the new potassium binders in novel ways to treat, uh, uh, dialysis patients.

Yeah, no, you're making a lot of good points here, Matt.

Okay, cool.

Take-home points now?

Let's go.

So with, with hyperkalemia, so in patients, uh, and, and this episode, this was great because we did a previous hyperkalemia episode, like, in 2017 that was really focused on the acute management and, uh, and inpatient management.

So for all new interns that are listening to this, go find that old episode of hyperkalemia.

I'm sure you'll put a link into the show notes.

It really covered very different ground than this one.

This episode is much more focused on, hey, you're in clinic and you got a patient with mild hyperkalemia.

How do we think about it? And we talked about pseudohyperkalemia.

We talked about, uh, the lack of a relationship between dietary potassium, so don't spend a lot of time focusing on dietary advice.

That's really not gonna be helpful in these patients.

You're gonna really go off in the wrong direction, and that we're gonna focus on, we went through a, a good list of the medications that cause hyperkalemia and how to think about those medications.

And then, uh, in terms of management, uh, you know, don't sleep on your diuretics.

Use your loop diuretics.

U- L- Use your thiazide type, type diuretics.

Go ahead and treat their metabolic alkalosis with some sodium bicarb- excuse me.

Go ahead and treat their metabolic acidosis with some sodium bicarbonate.

Get that corrected.

That is also gonna help that.

And then make sure that our patients are not constipated.

When it came to hypokalemia, we talked about, uh, uh, whether that can be, uh, renal losses or extrarenal losses, and that, uh, we talked about, um, magnesium as being an important component in that and the proton pump inhibitors being involved there.

Before that, we also went in and we talked about the potassium switch, which I just need to talk about 'cause I think it's so darn cool, and this potassium switch is new physiology that we've discovered where it's, uh, the kidney just not leaving anything to chance, taking care of that potassium.

That increased potassium intake has a thiazide-like effect, which is gonna cause increased potassium excretion and increased sodium excretion, so you'll get some hypotensive effect, and that that was put into action in the SASS trial in rural China where we were able to reduce not only stroke but total mortality by giving patients additional potassium chloride.

And then lastly, we finished off in the dialysis unit where you should always finish off your dialysis in the d- uh, always finish off your rounds in the dialysis unit, and we talked about using some of the new potassium binders in novel ways to treat, uh, uh, dialysis patients.