In hyperkalemia

Patients with tumor lysis syndrome experience a wide range of metabolic abnormalities. The massive cell lysis that occurs leads to the release of intracellular electrolytes, resulting in hyperkalemia and hyperphosphatemia. High concentrations of phosphate bind to calcium, leading to hypocalcemia and calcium phosphate precipitation in the renal tubule. Purine nucleic acids are also released that are subsequently metabolized to uric acid... 

Calcium gluconate - To decrease capillary permeability in allergic conditions, nonthrombocytopenic purpura and exudative dermatoses such as dermatitis herpetiformis for pruritus of eruptions caused by certain drugs in hyperkalemia, calcium gluconate may aid in antagonizing the cardiac toxicity, provided the patient is not receiving digitalis therapy. 

In hyperkalemia, infusion of glucose and insulin produces a shift of potassium into cells and lowers serum potassium levels. 

Because the actions of triamterene and amiloride are independent of plasma aldosterone levels, their prolonged administration is likely to result in hyperkalemia. Both amiloride and triamterene are contraindicated in patients with hyperkalemia. Triamterene should not be given to patients with impaired renal function. Potassium intake must be reduced, especially in outpatients. A folic acid deficiency has been reported to occur occasionally following the use of triamterene. 

Important drug interactions include those with potassium supplements or potassium-sparing diuretics, which can result in hyperkalemia. Nonsteroidal anti-inflammatory drugs may impair the hypotensive effects of ACE inhibitors by blocking bradykinin-mediated vasodilation, which is at least in part, prostaglandin mediated. 

Insulin is an endogenous hormone produced by fi-cells of islets of Langerhans of the pancreas, which consist of two chains of amino acids. It is required to be administered by a parenteral routes as it is destroyed when given orally. Insulin is used for the control of IDDM and in the emergency management of diabetic ketoacidosis.30 Insulin promotes the intracellular uptake of potassium and is used in hyperkalemia. Baker et al.31 have used insulin and glucagon in the treatment of liver disorders. Recent evidence indicates that the effects of insulin with glucose and potassium in ischemic heart disease have proved beneficial.32 It also is used in acute myocardial infarction.32... 

Indometacin reduces the effect of diuretics (69). Combination of indometacin with Moduretic (co-amilo-zide amiloride + hydrochlorothiazide) results in hyperkalemia (70). 

Sodium chloride solution has been advocated in hyperkalemia, in order to avoid the potassium-containing polyionic fluids (Table 17.4). However this does not apply to the horse in the absence of clinical signs of hyperkalemia and with the exception of horses with hyperkalemic periodic paralysis or with a ruptured bladder, the hyperkalemia is likely to reflect acidosis and polyionic fluids are probably appropriate. 

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