Parenteral Nutrition
Debunking Hyperkalemia Myths: What Clinicians Need to Know
H yperkalemia is a life-threatening electrolyte disturbance with significant implications for patient care. Despite its seriousness, several myths persist in clinical practice. In this article, we'll address these myths and provide evidence-based recommendations. Introduction to hyperkalemia Hyperkalemia affects 2.6-2.7% of the U.…
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Nutrition
Pharmacist's approach to manage acute HYPERkalemia
As a critical care pharmacist, both patiromer ( Veltassa ) and sodium zirconium cyclosilicate ( Lokelma ) can play a role in managing acute hyperkalemia, often in conjunction with other interventions. Both meds work similarly to sodium polystyrene sulfonate ( Kayexalate ), by binding potassium in the GI tract. Limited data suggest that potassium lowering is roughly c…
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Nutrition
Treatment of Hyponatremia
As a critical care pharmacist, your help will be needed to manage hyponatremia , the most common electrolyte disorder. Hyponatremia is linked to increased mortality and even minor hyponatremia is associated with mental status changes and falls. Emergent Hyponatremia Use 3% NaCl for SEVERE symptoms (coma, seizure, etc), no matter if h…
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Total parenteral nutrition
Make your ICU fluid stewardship
As a hospital pharmacist, you can improve fluid safety in the ICU, since fluids are used inappropriately in up to 20% of patients. Fluid stewardship aims to reduce harm by promoting judicious use during the “ROSE” phases r esuscitation or r escue, o ptimization, s tabilization, and e vacuation. Review fluids as you do other medications, right f…
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Nutrition
Errors when using IV fluids to treat HYPERnatremia
As a critical care pharmacist, you should take care from electrolyte disorders in adult patients in the intensive care unit (ICU). Errors continue to occur when using IV fluids to treat HYPOvolemic HYPERnatremia. Jump to IV fluids instead of enteral replacement if these patients are hemodynamically unstable or NPO, or have severe symptoms (seizure, etc). Follow these…
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Nutrition
Stay alert to drugs that cause hyponatremia
Questions are coming up about medications-induced hyponatremia. Low sodium levels are the most common electrolyte disturbance. Symptoms are rare with mild drops below 135 mEq/L that develop over time. But severe or rapid drops in sodium below 125 mEq/L can cause coma or seizures. Plus, chronically low sodium in older patients is linked with cognitive impairment, …
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Nutrition
Best approach for treating HYPOnatremia
What is the best approach for teating hyponatremia? ㅡ Usually focus on the symptoms more than the sodium level. We know to immediately treat SEVERE symptoms such as seizure and coma with hypertonic saline to prevent brain herniation and death. But other cases of hyponatremia aren't as clear cut. Consider a single bolus of 100 to 150 mL …
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Nutrition
Treatment of hypokalemia
Overview ㅡ Normally, blood potassium level is 3.5 to 5.5 mEq/L or mmol/L (1 mEq = 1 mmol potassium). Hypokalemia is usually defined as a serum potassium level ≤ 3.5 mmol/L. Up to 21% of hospitalized patients develop hypokalemia during their stay, with 5.2% being classified as severe (< 3.0 mmol/L). Up to 40% of outpatient treated with diuretics suffer from hypokal…
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Nutrition
Be ready to treat HYPERKALEMIA in hospital
HYPERKALEMIA is the most dangerous electrolyte abnormality. It may result in sudden arrhythmogenic death because of its effect on the cells’ resting membrane potentials. The most common explanation for hyperkalemia is often referred to as laboratory error Actually, the laboratory does the right analysis, but the serum sample has hemolyzed after (or while) being draw…
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Nutrition
Be skilled in controlling POTASSIUM levels for patients with heart failure
Getting POTASSIUM levels right for patients with heart failure can be a balancing act due to changes in medications, diet and kidney function. Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts. Diuretic use and gastrointestinal losses are common causes of hypokalemia, while…
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Sepsis
Consider LACTATED ringer's over normal saline for fluid resuscitation
As a hospital pharmacist, you'll hear debate over using Lactated Ringer's or other balanced fluids instead of normal saline for fluid resuscitation. Balanced fluids, such as Lactated Ringer's (LR) or Plasma-Lyte , are touted as having electrolyte content similar to plasma, while normal saline has higher levels of chloride. The concern is that large volum…
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Nephrology and Urology
Managing CHRONIC hyperkalemia
How to manage chronic hyperkalemia? ― Hyperkalemia is a potentially life-threatening metabolic problem caused by inability of the kidneys to excrete potassium. We know ACEIs, ARBs, or aldosterone antagonists (spironolactone, etc) can raise potassium levels especially in chronic kidney disease, etc. Sodium polystyrene sulfonate ( Kayexalate , etc) is a potassium binde…
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Side Effects
Using of potassium binders when ACEIs or ARBs cause hyperkalemia
New Rx Lokelma will pique interest in the role of potassium binders to treat CHRONIC high potassium due to ACEIs or ARBs. Think of Lokelma (sodium zirconium cyclosilicate) as most similar to sodium polystyrene sulfonate ( Kayexalate , etc) for hyperkalemia. Both exchange sodium to bind potassium. Lokelma also exchanges hydrogen. But Lokelma may cause fewer GI side e…
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