T waves peaked

Hyperkalemia is defined as a serum potassium concentration greater than 5 mEq/L (5 mmol/L). Manifestations of hyperkalemia include muscle weakness, paresthesias, hypotension, ECG changes (e.g., peaked T waves, shortened QT intervals, and wide QRS complexes), cardiac arrhythmias, and a decreased pH. Causes of hyperkalemia fall into three broad categories (1) increased potassium intake (2) decreased potassium excretion and (3) potassium release from the intracellular space. 

The earliest ECG change (serum potassium 5.5 to 6 mEq/L) is peaked T waves. The sequence of changes with further increases is widening of the PR interval, loss of the P wave, widening of the QRS complex, and merging of the QRS complex with the T wave resulting in a sine-wave pattern. 

ECG changes include widened QRS complexes and peaked T waves in mild deficiency. Prolonged PR intervals, progressive widening of the QRS complexes, and flattening of T waves occur in moderate to severe deficiency. 

K /Na exchange in distal tubule Dose Adults. 5-10 mg PO daily Peds. 0.625 mg/kg/d X in renal impair Caution [B, ] Contra T K, SCr >1.5 mg/dL, BUN >30 mg/dL, diabetic neuropathy Disp Tabs SE T K HA, dizziness, dehydration, impotence Interactions T Risk of hyperkalemia W/ ACEI, K-sparing diuretics, NSAIDs, K salt substitutes T effects OF Li, digoxin, antihypertensives, amantadine T risk of hypokalemia W/ licorice EMS Monitor ECG for signs of hyperkalemia (peaked T waves) T effects of digoxin OD May cause bradycardia, light-headedness, and syncope symptomatic and supportive... 

Epoetin Alfa [Erythropoietin/ EPO] (Epogen/ Procrit) [Recombinant Human Erythropoietin] WARNING Use lowest dose possible may be associated w/1 CV, thromboembolic events /or mortality D/C if Hgb >12 g/dL Uses CRF associated anemia zidovudine Rx in HIV-infected pts, CA chemo -1- transfusions associated w/ surgery Action Induces ery-thropoiesis Dose Adul Peds. 50-150 Units/kg IV/SQ 3x/wk adjust dose q4-6wk PRN Surgery 300 Units/kg/d x 10 d before to 4 d after -I dose if Hct 36% or Hgb, T > 12 g/dL or Hgb t >1 g/dL in 2-wk pmod hold dose if Hgb >12 g/dL Caution [C, +] Contra Uncontrolled HTN Disp Inj SE HTN, HA, fatigue, fever, tach, NA Interactions None noted EMS Monitor ECG for hypokalemia (peaked T waves) t risk of CV thrombotic events OD May cause HA, dizziness, SOB and polycythemia symptomatic and supportive... 

ASA, NSAIDs, food EMS Monitor ECG for hypokalemia (peaked T waves), esp in pts taking K-sparing diuretics may affect glucose (hypoglycemia) concurrent EtOH use can t adverse effects may cause posistent cough OD May cause profound hypotension give IV fluids... 

Use in PRG in 2nd/3rd tri can result in fetal death Uses HTN, CHF, LVD, post-AMI Action ACE inhibitor Dose HTN 2- mg/d CHF/LVD 4 mg/d i w/ severe renal/h atic impair Caution [D, +] ACE inhibitor sensitivity, angioedema w/ ACE inhibitors Disp Tabs SE X BP, bradycardia, dizziness, t K, GI upset, renal impair, cough, angioedema Notes African Americans, minimum dose is 2 mg vs 1 mg in Caucasians Interactions t Effects W/ diuretics t effects OF insulin, Li -1- effects W/ ASA, NSAIDs EMS Monitor ECG for hyperkalemia (peaked T waves), esp in pts taking K-suppl OD May cause profound hypotension give IV fluids... 

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