#137 Hyperkalemia Master Class with Joel Topf MD

Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Sponsor Join us at ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there! Credits Written and produced by: Matthew Watto, MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Infographic: Matthew Watto MD Edited by: Matthew Watto MD Guest: Dr Joel Topf MD Time Stamps 00:00 Ad disclaimer, intro and guest bio 05:11 Guest one-liner and picks of the week —Peloton indoor cycle, “your local library”, The Nice Guys (film) by Shane Black, and Forgotten Hand (PS4 game) 11:17 ACP Internal Medicine Meeting 2019 details 12:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia 19:55 Hyperkalemia and the EKG 23:38 Threshold for treatment of hyperkalemia 27:20 Use of telemetry and the U-shaped curve for potassium and mortality 30:11 Choice of therapy for acute hyperkalemia 33:13 Albuterol for hyperkalemia 34:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring 39:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron 43:10 Fludrocortisone for hyperkalemia 45:05 Calcium for elevated potassium 48:43 SPS, potassium binding resin 52:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis 58:28 Sodium bicarbonate for acute and chronic hyperkalemia 61:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia 63:05 Threshold for admission; Diet and potassium 65:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods 68:45 Patiromer and sodium zirconium 71:51 Loop diuretics and empiric potassium supplementation 74:12 Can diet alone be used to treat HYPOkalemia? 75:26 Take home points 77:40 NephMadness is coming! March 2019 79:53 Outro 81:00 More Kidney Boy!