Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hyperkalemia


Related Terms

  • High Potassium

Differential Diagnosis

  • Hypocalcemia
  • Other causes of irregular heart rhythms (arrhythmias)
  • Pseudohyperkalemia (due to hemolysis, thrombocytosis, leukocytosis)

Specialists

  • Critical Care Internist
  • Emergency Medicine Physician
  • Endocrinologist
  • Family Physician
  • Internal Medicine Physician
  • Nephrologist

Comorbid Conditions

  • Cardiac disorders
  • Endocrine disorders
  • Gastrointestinal disorders
  • Renal disease

Factors Influencing Duration

Disability time varies according to the underlying problem, severity of the condition, and type of treatment required. The length of disability depends primarily on the underlying cause. In mild cases with a reversible problem, such as a drug side effect, disability time should be minimal. Serious hyperkalemia that involves hospitalization or dialysis may require a longer period of disability.

Medical Codes

ICD-9-CM:
276.7 - Hyperpotassemia; Hyperkalemia; Potassium [K]: Excess, Intoxication, Overload

Overview

Hyperkalemia is a serious condition in which potassium levels in the bloodstream become elevated. Potassium is necessary for normal cellular metabolism and electrical impulse transmission in nerves and muscles, which in turn is necessary for normal nervous system function and muscle contraction. Potassium is found in foods such as bananas, oranges, baked potatoes, fish, beans, dairy products, and certain salt-substitutes. The kidneys usually eliminate any excess potassium; when this does not occur, potassium levels rise. This can lead to muscle weakness or paralysis, heart problems, and in severe cases, death from irregular heart rhythms (cardiac arrhythmias).

Usually, hyperkalemia is found in individuals with kidney problems, especially those with diabetes and aldosterone abnormalities (type 4 renal tubular acidosis, adrenal insufficiency). It can also develop in individuals taking oral potassium supplements, potassium-sparing diuretics, aldosterone blockers, certain antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), some transplant medications, digoxin, and drugs that can cause muscle cell breakdown (rhabdomyolysis). It can also be a complication of dehydration, severe burns, internal bleeding, and muscle trauma.

Incidence and Prevalence: The incidence ranges from 1.1% to 10% in hospitalized patients, and the prevalence of hyperkalemia ranges from 5% to 10% in patients with end-stage renal disease (Anderson 1017).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Among patients under 60 years of age, the risk is highest in those with end-stage renal disease. In patients over 60, decreased renal function, the presence of hyperglycemia, and the use of medications that can increase potassium levels increase the risk of hyperkalemia.

Source: Medical Disability Advisor



Diagnosis

History: Hyperkalemia can be difficult to diagnose clinically because there are no distinctive signs and symptoms. Mild hyperkalemia can be recognized only because of an abnormally high potassium blood test result. Individuals with moderate or severe hyperkalemia may report weakness, fatigue, numbness, or an irregular heartbeat (palpitations). In rare cases, there is generalized muscle paralysis.

Physical exam: Physical findings may include decreased reflexes, decreased muscle strength on testing, a slow or irregular heartbeat, pauses or extra heartbeats, and in the most severe cases, respiratory and cardiac arrest. If the underlying cause of hyperkalemia is renal failure, there may be physical signs such as edema or other skin changes. The presence of symptoms is influenced by how rapidly the potassium level has risen.

Tests: Hyperkalemia is defined as a blood potassium level higher than 5.5 mEq/liter. Blood potassium levels from 5.5 to 6.0 mEq/liter are considered mildly elevated; 6.1 to 7.0 mEq/liter moderately elevated; and higher than 7.0 mEq/liter severely elevated.

Other blood tests that may be done include BUN and creatinine to evaluate kidney function; a urinalysis if there are signs of kidney failure; a calcium level especially if the individual has renal failure; a glucose level in individuals with diabetes mellitus; and a digoxin level if the individual takes heart medications.

An electrocardiogram is usually done to determine any impact on the heart, and additional tests may be done to determine the cause of the hyperkalemia if it is not apparent.

Source: Medical Disability Advisor



Treatment

When hyperkalemia is the result of a drug complication, removing the offending drug will usually correct the problem. When hyperkalemia is chronic and not life-threatening, treatment measures include a diet low in potassium, discontinuation of potassium supplements, avoidance of medications that can raise potassium (beta-blockers, ACE-inhibitors, ARBs, potassium-sparing diuretics, NSAIDs, digoxin, transplant medications, aldosterone blockers), and the use of loop or thiazide diuretics, which promote potassium elimination by the kidneys. Oral potassium-binding resins such as Kayexalate (sodium polystyrene sulfonate) and fludrocortisone (in cases of aldosterone deficiency) also help promote potassium elimination by the kidneys.

In cases of severe hyperkalemia, the individual is hospitalized for monitoring and treatment. This may include intravenous calcium salts, fluids containing glucose, insulin, loop diuretics, and/or sodium bicarbonate. In addition, potassium-binding resins, given orally or by enema, and nebulizer treatments containing albuterol may be used. These treatments all work in various ways to help lower the blood level of potassium. If the hyperkalemia does not improve, dialysis may be needed.

Source: Medical Disability Advisor



Prognosis

Most individuals with hyperkalemia respond favorably to treatment. The underlying cause of the hyperkalemia, such as diabetes or chronic renal failure, has the greatest impact on long-term outcome.

Source: Medical Disability Advisor



Complications

Undiagnosed and untreated severe hyperkalemia may lead to respiratory or cardiac arrest. Overly aggressive treatment of hyperkalemia may lead to low blood levels of potassium (hypokalemia).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Generally, any restrictions or accommodations would be related to the underlying cause of the hyperkalemia, not the hyperkalemia itself. No restrictions or accommodations should be necessary once the individual returns to work.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has diagnosis of hyperkalemia been confirmed?
  • Has pseudohyperkalemia been excluded?
  • Has underlying cause of the hyperkalemia been identified?
  • Does individual have a coexisting condition, such as kidney disease, diabetes mellitus, or a gastrointestinal or cardiac condition that may complicate treatment or affect recovery?

Regarding treatment:

  • If hyperkalemia was the result of a drug complication or a potassium supplement, were those discontinued as part of the treatment?
  • If hyperkalemia was the result of a drug complication, did removing the offending drug correct the problem?
  • Has individual been able to comply with a diet low in potassium? Would individual benefit from consultation with a nutritionist?
  • Has drug therapy effectively lowered the blood potassium level?
  • If hyperkalemia was a result of a medical condition (not a drug side effect), was the underlying medical problem treated accordingly?
  • If hyperkalemia did not improve with drug therapy, did hyperkalemia respond to dialysis? Is continued or future dialysis anticipated?

Regarding prognosis:

  • Has the underlying cause of the hyperkalemia, such as diabetes or chronic renal failure, responded to treatment? What does follow-up entail?
  • Would individual benefit from consultation with a specialist (internist, nephrologist, endocrinologist)?

Source: Medical Disability Advisor



References

Cited

Anderson, Sharon, et al. "Hyperkalemia." Brenner & Rector's The Kidney. 7th ed. Philadelphia: W.B. Saunders, 2004. 1017-1025.

Source: Medical Disability Advisor






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