Discussion: A 75-year-old male with a history of hypertension, diabetes, and CKD stage 3b Case study
Discussion: A 75-year-old male with a history of hypertension, diabetes, and CKD stage 3b Case study
please answer DQ in full, minimum 250 words thank you
A 75-year-old male with a history of hypertension, diabetes, and CKD stage 3b presented to your ED with a K of 5.8 and a creatinine of 4.2. Choose one of the following issues to address in your response. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
What are possible differentials/contributors to elevated potassium levels? What cardiac findings would you expect to see? What treatments are available for hyperkalemia?
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Does this patient have a current indication for dialysis? What additional information would help you make this determination? What types of dialysis exist? Compare benefits, burdens, complications, long-term outcomes, and cost of each.
What are nutritional considerations related to chronic kidney disease that are relevant to this patient? What are complications related to both advanced renal disease and long-term dialysis, including anemia and bone metabolism disorders? How can one manage and prevent symptoms related to advanced renal disease and long-term dialysis?
How would you approach goals of care and advanced care planning with this patient? What do you know about advanced renal disease and quality of life considerations? What can you tell him about medical management versus dialysis in advanced renal disease in a person his age?
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Discussion Question: 1
Hyperkalemia is a serum potassium level higher than 5.0 mEq/L. The normal range for serum potassium values is usually narrow. Thus even slight increases above normal values can affect excitable tissues. Hyperkalemia is caused by an actual increase in total body potassium or from the movement of potassium from the cells into the blood. Causes of elevated serum potassium levels include over-ingestion of potassium-containing foods or medications like salt substitutes, Potassium chloride, rapid infusion of potassium-containing IV solutions, and bolus IV potassium injections (Hunter & Bailey, 2019). Hyperkalemia can also be attributed to adrenal insufficiency in Addison’s disease and adrenalectomy, as well as kidney failure. In addition, medications like potassium-sparing diuretics and ACEIs contribute to elevated potassium levels. Transfusion of whole blood or packed cells is also associated with elevating potassium levels. Relative potassium excesses are caused by Tissue damage, acidosis, hyperuricemia, and uncontrolled diabetes mellitus.
Cardiovascular changes are the most severe problems of hyperkalemia and are usually the most common cause of mortality in patients with hyperkalemia. Cardiac manifestations of hyperkalemia include hypotension, bradycardia, and ECG changes. The ECG changes include prolonged PR intervals, tall peaked T waves, flat or absent P waves, and wide QRS complexes (Hunter & Bailey, 2019). As serum potassium levels increase, heartbeats generated outside the normal conduction system in the ventricles can appear. Severe hyperkalemia is associated with life-threatening complications like complete heart block, ventricular fibrillation, and asystole. Treatments for hyperkalemia include IV fluids containing glucose and insulin (100 mL of 10% to 20% glucose with 10 to 20 units of regular insulin), which decrease serum potassium levels (Weinstein et al., 2021). Potassium-excreting diuretics, like furosemide, are also prescribed.
References
Hunter, R. W., & Bailey, M. A. (2019). Hyperkalemia: pathophysiology, risk factors and consequences. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association – European Renal Association, 34(Suppl 3), iii2–iii11. https://doi.org/10.1093/ndt/gfz206
Weinstein, J., Girard, L. P., Lepage, S., McKelvie, R. S., & Tennankore, K. (2021). Prevention and management of hyperkalemia in patients treated with renin-angiotensin-aldosterone system inhibitors. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne, 193(48), E1836–E1841. https://doi.org/10.1503/cmaj.210831
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