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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Jan 28, 2019

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.

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Join us at ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there!


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!