Ep3: Hyperkalemia (MACHINE, MURDER, AIRED)

nursing mnemonic podcast

Hyperkalemia Nursing Mnemonics


The hyperkalemia MACHINE 


Medications – ACE Inhibitors, NSAIDS, potassium-sparing diuretics

Acidosis – Metabolic and respiratory

Cellular destruction – burns, traumatic injury, hemolysis

Hypoaldosteronism – Addison’s

Intake- excessive

Nephrons- renal failure

Excretion – Impaired


Muscle weakness

Urine- oliguria, anuria

Respiratory distress

Decreased cardiac contractility

ECG changes

Reflexes- hyperreflexia, or areflexia (flaccid)




Administer IV Calcium – to immediately decrease cardiac toxicity

Increase excretion – via both stool (kayexlate) and urine (diuretics)

Remove sources of potassium – from all sources, including enteral, pareteral, IV,   and PO

Enhance potassium uptake into cells – insulin, glucose, sodium bicarb, beta-adrenergic antagonists

Dialysis – emergent response for patients with lethal hyperkalemia




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Podcast Transcription

Alright, for this mnemonic, I’m gonna be talking specifically about hyperkalemia. There’s multiple mnemonics I’m gonna discuss but I wanna give a definition of what hyperkalemia is first. So, hyperkalemia is elevated potassium in the blood. Typical normal levels are 3.7 to about 5.2 mEq/L. So, a lot of things can cause this to occur. For example, in acidosis and cellular destruction, potassium zest from inside the cell to the bloodstream which can cause this hyperkalemia. Medications and kidney damage can also decrease your excretion of potassium, therefore, increasing your serum potassium. Also, excessive intake of potassium. So, a lot of things can really alter this. Something that you do wanna be aware of with potassium abnormality is, is potassium is necessary for the transmission of electrical impulses in your heart and skeletal muscles. Therefore, if you have hyperkalemia, this can cause EKG changes. So, it’s really really important that if you’re noticing a patient that’s having this weird funky EKG things going on, take a peek at your labs and see when the last time they had a BMP or a CMP drawn and see what their potassium is, can really tell you a lot about what’s going on.


So, there’s a couple of mnemonics I wanna go over that will help you remember some of the things related to hyperkalemia. So, this is a mnemonic to remember, the causes of hyperkalemia. So, the mnemonic is MACHINE. MACHINE. So, M – Medications, things like ACE inhibitors, NSAIDs and potassium sparing diuretics can all increase the potassium. So, MACHINE, M – Medications. A – Acidosis, so, metabolic and respiratory acidosis, like I said, that can cause hyperkalemia. So, A – Acidosis. C – Cellular destruction. So, burns, traumatic injuries, hemolysis, cellular destruction, C. H – Hypoaldosteronism or Addison’s Disease, H. I – Intake, so, an excessive intake of potassium. N – Nephrons, renal failure, N – Nephrons, renal failure. E – Excretion impaired. So, they’re having problems getting rid of their potassium. So, MACHINE. Medications, Acidosis, Cellular Destruction, Hypoaldosteronism, Intake, Nephrons, and Excretion. All things that can cause hyperkalemia.


Next thing I wanna talk about are some of your signs and symptoms of hyperkalemia. MURDER. MURDER. M- Muscle weakness. U – Urine, so oliguria and urea. R – Respiratory distress. D – Decreased cardiac contractility. E – ECG Changes. Remember we were talking about ECG changes with hyperkalemia. And R – Reflexes, hyperreflexia or areflexia, they’re flaccid. So, MURDER, MURDER. Muscle Weakness, Urine, Respiratory Distress, Decreased Cardiac Contractility, EKG Changes and Reflexes.


Next thing I wanna talk about with hyperkalemia is the management AIRED, AIRED. AIRED, Administer IV calcium, this immediately decreases the cardiac toxicity that occurs with hyperkalemia. I – Increased excretion. So, you wanna give stuff to excrete  the potassium whether that be via stool via K oxalate or via urine like some diuretics. So, I – Increased excretion. R – Remove sources of potassium. So, you’re removing all IV, oral, everything, all sources of potassium. So, if they are on TPN, you gotta look ‘cause a lot of TPN will have some potassium in there. Are they getting enteral nutrition that has potassium in there. Or, are they eating a bunch of bananas? Got to remove sources of potassium. E – Enhance potassium uptake into the cell. So, you want to increase pulling potassium from outside of the cell to inside the cell. And what is that? Insulin, glucose, sodium bicarb, beta adrenergic antagonist as well. So, E – Enhanced potassium uptake into cells. And the last thing is Dialysis. This is an emergent response for patients with lethal hyperkalemia. So, D – Dialysis. AIRED. Administer IV calcium, I – Increase excretion, R – Remove sources of potassium, E – Enhance potassium uptake into the cells, and D – Dialysis.


This has been another episode of the nursing mnemonics podcast by NRSNG.com with your host, Katie Kleber, RN, CCRN. To grab all of our cheat sheets, head over to NRSNG.com/freebies. That’s NRSNG.com/freebies. Thank you so much for being here today. We love you guys. We thank you so much. We want to see you guys succeed. Listen, we’re all in this together. Now, go out and be your best self today. Happy Nursing.


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