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A Curbsiders classic with a fresh intro by Hannah Abrams @hannahRabrams (soon to be 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. Get deeper into potassium physiology with a FREE pdf copy of Joel’s book The Fluid Electrolyte and Acid Base Companion here. Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | [email protected] Sponsor ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20 Credits Written, edited and produced by: Matthew Watto MD, FACP Intro: Hannah R Abrams Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD Infographic and Cover Art: Matthew Watto MD, FACP Guest: Joel Topf MD Time Stamps 00:00 Sponsor -ACP’s IM Meeting 2020 in LA 00:28 Disclaimer, intro and guest bio 03:00 Guest one-liner Picks of the week* —Peloton indoor bike; The Nice Guys (film) by Shane Black; Forgotten Anne (PS4 videogame), “your local library” 09:00 Sponsor -ACP’s IM Meeting 2020 in LA 09:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia 17:00 Hyperkalemia and the EKG 20:31 Threshold for treatment of hyperkalemia 24:20 Use of telemetry and the U-shaped curve for potassium and mortality 27:11 Choice of therapy for acute hyperkalemia 30:13 Albuterol for hyperkalemia 31:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring 36:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron 40:10 Fludrocortisone for hyperkalemia 42:05 Calcium for elevated potassium 45:43 SPS, potassium binding resin 49:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis 55:28 Sodium bicarbonate for acute and chronic hyperkalemia 58:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia 60:05 Threshold for admission; Diet and potassium 62:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods 65:45 Patiromer and sodium zirconium 68:51 Loop diuretics and empiric potassium supplementation 71:12 Can diet alone be used to treat HYPOkalemia? 72:26 Take home points 74:40 NephMadness is coming! March 2019 76:53 Outro 78:00 Stuart’s shares a few puns *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr Topf’s blog lists the following disclosures “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018”. The Curbsiders were sponsored by ACP’s Internal Medicine Meeting 2019 for this episode. Citation Topf J, Williams PN, Brigham SK, Watto MF. “#137 Hyperkalemia Master Class with Joel Topf MD.” The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date: January 28, 2019.