2) . . . Supported by educational grant funding from Abbott, AstraZeneca, Bayer, Chiesi, NovoNordisk. Follow this thread for credit. And here is a case . . .
— cardio-met (@cardiomet_CE) March 22, 2021
4) P 75, BP 110/60, listless. Mucous membranes dry, appears chronically ill. Serum K is 6.3, SCr is 4.3 (one year ago was 3.3). Sodium is 148 . . .
— cardio-met (@cardiomet_CE) March 22, 2021
6) Which of the following would NOT be a reasonable strategy to treat this patient in the ED for quick stabilization of his hyperkalemia?
— cardio-met (@cardiomet_CE) March 22, 2021
8) Welcome back to our accredited tweetorial on the management of acute hyperkalemia. I am @md_pollack. Check out the poll results. “Typical” ECG findings are not always present with hyperkalemia, but when present may arouse suspicion even before lab results come back . . . pic.twitter.com/Qf8rWb5LJs
— cardio-met (@cardiomet_CE) March 23, 2021
10) . . . . . . and actual removal of K+ from the body. For stabilization, those poll options of glucose/insulin, albuterol, and calcium are all helpful. Bicarb may also help by driving K+ into cells in exchange for buffering H+. pic.twitter.com/tUdazMWIr0
— cardio-met (@cardiomet_CE) March 23, 2021
12) Intravenous calcium salts should be administered immediately in hyperkalemic patients presenting with ECG changes. Since administration of calcium salts does not result in a lowering of potassium concentrations, other measures have to be taken to shift potassium . . .
— cardio-met (@cardiomet_CE) March 23, 2021
14) Sodium bicarbonate activates the Na+/K+-pump and corrects an underlying metabolic acidemia, potentially resulting in a lowering of serum potassium values by shifting K into cells, but data on effectiveness are conflicting.
— cardio-met (@cardiomet_CE) March 23, 2021
16) So we have these two “next-generation” potassium binders approved by the FDA: SZC and patiromer. For acute hyperkalemia, there is one important difference between the two new binders. What is the difference?
— cardio-met (@cardiomet_CE) March 23, 2021
18) Welcome back. I am @md_pollack. For acute hyperK, the difference between SZC and patiromer is the site of GI absorption (both are only given orally). SZC works faster because it is absorbed more proximally, in the small bowel. SZC may bind K throughout the entire GI tract. pic.twitter.com/nn1ukZCU9i
— cardio-met (@cardiomet_CE) March 24, 2021
20) . . . and preferentially capturing K+, thus increasing fecal excretion K+. Its selectivity for K is ~ 25 times greater than that for Ca++ or Mg++. Patiromer works by binding the free K+ in the GI tract, mainly in distal colon lumen, and releasing Ca++ for exchange.
— cardio-met (@cardiomet_CE) March 24, 2021
22) SZC can transiently increase gastric pH, potentially affecting absorption of co-administered drugs with pH-dependent solubility. There may be an increase in exposure to weak acids (like furosemide, atorvastatin), so hold other oral meds for 2h before and after SZC.
— cardio-met (@cardiomet_CE) March 24, 2021
24) No diff in K+ at 1 h with SZC vs placebo, probably due to concomitant insulin and glucose treatment. A greater reduction in mean K+ from the baseline was observed in the SZC group, compared with the placebo at 2 hours (−0.72 vs. −0.36 mmol/L, respectively), suggesting . . .
— cardio-met (@cardiomet_CE) March 24, 2021
26) Return tomorrow for poll results and your link for free 0.5h CE/CME for physicians, pharmacists, and nurses! Nod to @academiccme #cardiotwitter @SnayCardsPharmD #hyperkalemia @CaseKidneys @ANNAnurses @RenalFellowNtwk @ISNkidneycare @VijayanMD @MGHKidneys
— cardio-met (@cardiomet_CE) March 24, 2021
30) This, along with hydration and further support, will likely help stabilize the patient and if HD is still needed, it can be sought during more convenient hours.
— cardio-met (@cardiomet_CE) March 25, 2021
32) So you made it! Free CE/#CME! Physicians, pharmacists, nurses: go to https://t.co/Yw9tH7GMpA and claim your credit! I am @md_pollack. Follow @cardiomet_CE for more tweetorials! #medtwittter #cardiotwitter @silviajulianalm @KIReports @DavidJuurlink @Med_Life_Crisis
— cardio-met (@cardiomet_CE) March 25, 2021