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.0.0 RSP Endocrine > [9] Hyperkalaemia > Flashcards

[9] Hyperkalaemia Flashcards

1
Q

What is classified as hyperkalaemia?

A

A serum potassium of greater than 5.5mmol/L

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2
Q

When is hyperkalaemia usually asymptomatic?

A

At relatively low levels

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3
Q

Why is hyperkalaemia a very important condition to identify and treat early?

A

Due to cardiac and other complications that can arise

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4
Q

What are the causes of hyperkalaemia?

A
  • Oliguric renal failure
  • Potassium sparing diuretics
  • Rhabdomyolysis
  • Metabolic acidosis
  • Excess potassium therapy
  • Addison’s disease
  • Massive blood transfusion
  • Burns
  • Drugs
  • Artefactual result
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5
Q

Give an example of a drug that can cause hyperkalaemia?

A

ACE inhibitors

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6
Q

What should be done if a patient is found on testing to be hyperkalaemic but they do not display any signs or symptoms of hyperkalaemia?

A

The test should be repeated urgently, as it may be artefactual

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7
Q

What can cause an artefactual hyperkalaemia result?

A
  • Haemolysis
  • Contamination with potassium EDTA in FBC bottles
  • Thrombocythaemia
  • Delayed analysis
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8
Q

What can cause haemolysis leading to an artefactual hyperkalaemia result?

A
  • Difficult venepuncture
  • Patient clenching their fist
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9
Q

How can thrombocythaemia cause an artefactual hyperkalaemia result?

A

Because potassium leaks out from platelets during clotting

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10
Q

How can delayed analysis lead to an artefactual hyperkalaemia result?

A

Potassium leaks out of RBCs

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11
Q

Below what serum potassium concentration are symptoms rare in hyperkalamia?

A

Less than 7.0mmol/L

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12
Q

What are the signs and symptoms of hyperkalaemia?

A
  • Fast, irregular pulse
  • Chest pain
  • Weakness
  • Palpitations
  • Light-headedness
  • Paresthesia
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13
Q

When should clinical assessment in hyperkalaemia take place?

A

Needs to be timely, and is often performed simultaneously with treatment

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14
Q

What is involved in the clinical assessment of hyperkalaemia?

A
  • Urine output
  • Review of potassium intake
  • Review of drugs
  • Review history for possible causes of renal disease or major tissue destruction
  • Fluid status
  • Review recent biochemistry results, in particular renal function and potassium levels
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15
Q

What sources of potassium intake need to be reviewed in hyperkalaemia?

A
  • IV fluids
  • Potassium supplements
  • Diet
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16
Q

What drugs should be reviewed in hyperkalaemia?

A
  • ACE inhibitors
  • Angiotensin II receptor blockers
  • Potassium sparing diuretics
17
Q

What should be involved in a fluid status assessment?

A

Look for signs of dehydration or fluid overload

18
Q

Describe the importance of ECG in hyperkalaemia

A

The ECG is vital in the assessment of hyperkalaemia, with the findings progressing with increasing serum potassium levels

19
Q

Describe the relationship between serum potassium concentration and ECG

A

While ECG findings can generally be correlated to serum potassium concentration, potentially life-threatening arrhythmias can occur without warning at almost any level of hyperkalaemia

20
Q

What is considered to be mild hyperkalaemia?

A

5.5-6.5mmol/L

21
Q

What are the ECG findings in mild hyperkalaemia?

A
  • Tall ‘tented’ T waves seen across the precordial leads
  • Prolonged PR segment
22
Q

What is considered to be moderate hyperkalaemia?

A

6.5-7.5mmol/L

23
Q

What are the ECG findings in moderate hyperkalaemia?

A
  • Decreased or ‘flattened’ P wave
  • Prolonged QRS complex
24
Q

What is considered to be severe hyperkalaemia?

A

>7.5mmol/L

25
Q

What are the ECG findings in severe hyperkalaemia?

A
  • Progressive widening of QRS complex
  • Axial deviation and bundle branch blocks
26
Q

What may eventually happen to the ECG in hyperkalaemia?

A

The progressively widened QRS eventually merges with the T wave, forming a sine wave pattern. Subsequent ventricular fibrillation or asystole may then follow

27
Q

When should you seek expert renal advice in hyperkalaemia?

A

If potassium is >6.5mmol/L or there are ECG changes, and the patient is oligo/anuric

28
Q

How should hyperkalaemia be managed when potassium is >6.5mmol/L, or there are ECG changes?

A
  • Monitor cardiac rhythm
  • Calcium gluconate 10% 10ml undiluted over 5 mins. Repeat at 5 min intervals as needed, until ECG is normal, with a maximum of 3 doses in total
  • 10 units insulin + glucose 50% 50ml, give into large vein over 30 minutes
  • Salbutamol 10mg nebuliser
  • Stop all potassium containing/sparing drugs, and treat hypotension
29
Q

What monitoring should be done when you give a patient 10 units insulin + glucose 50% 50ml?

A

Monitor BMs after 15 and 30 minutes, then hourly

30
Q

When should you exercise caution in giving patients salbutamol in hyperkalaemia?

A

In patients with a history of arrhythmias in IHD

31
Q

When should you consider giving sodium bicarbonate in hyperkalaemia?

A

If pH <7.2

32
Q

How often should you recheck potassium in hyperkalaemia when potassium is >6.5mmolL or there are ECG changes?

A

Every 2 hours

33
Q

When might a patient with hyperkalaemia need dialysis?

A

If they develop renal failure, or are oligo/anuric

34
Q

How is hyperkalaemia managed when potassium 6.0-6.5mmol/L with no ECG changes?

A
  • Exclude pseudohyperkalaemia
  • Stop all potassium containing/sparing drugs
  • Low potassium diet
  • Ensure adequate hydration, and monitor urine output
  • Monitor renal function
  • Remove excess potassium using calcium resonium 15g PO
35
Q

When should you stop calcium resonium?

A

Consider stopping when <6.0mmol/L. Stop when <5.5mmol/L

36
Q

How is hyperkalaemia managed if potassium <6.0mmol/L and renal function is stable?

A

No urgent action is required, arrange dietary modification and medication review

.0.0 RSP Endocrine (18 decks)

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