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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Optimizing Meds
Optimizing meds in patients with HFrEF and CKD
Few patients with chronic kidney disease (CKD) are on optimized meds for heart failure with reduced ejection fraction (HFrEF) . It’s a delicate balance... Hyperkalemia can occur with an ACEI or ARB, Entresto (sacubitril/valsartan), or an aldosterone antagonist. Plus, these meds or SGLT2 inhibitors ( Forxiga, etc ) can cause an initial bump in serum creatinine…
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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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Trimethoprim
Think carefully before prescribing Septazole with potassium-boosting drugs
AS A PHARMACIST, you will hear more about possible harm when TMP/SMX ( Bactrim, Septrin, Septazole , etc) is combined with medications that increase potassium ( ACEIs , spironolactone , etc). This interaction is more risky than previously thought and is popping up on more drug interaction software . Trimethoprim decreases urinary excre…
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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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TMP/SMX
Trimethoprim/sulfamethoxazole (TMP/SMX) in combination with drugs that increase potassium
As a pharmacist, you should be be careful when use of trimethoprim/sulfamethoxazole ( Bactrim, Septrin, etc) in combination with drugs that increase potassium like angiotensin converting enzyme inhibitors (ACEI) , angiotensin receptor blockers (ARBs) or spironolactone. Remmember that trimethoprim/sulfamethoxazole labeling has a precaution about hyperkalemia, and …
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