electrolyte abnormalities

Question 1

managing hyperK+

what are your three principles?

Answer 1

1. protect the heart
   give 10 ml of 10% calcium gluconate solution - slow IV injection over 3-5minutes. Titrate and adjust to ECG. may need repeated doses!!
2. reduce the SERUM K+ concentration
   IV injection of 5-10 units of Actrapid with 50ml glucose 50% - give over 15mins to drive the K+ into the cells
   Salbutamol nebs (caution in patients with IHD or Hx of arrythmias)
3. excrete / remove the excess serum potassium from the body
   give oral calcium resonium
   dialysis may be needed..

Question 2

if the patient is on which drug do you need to be careful when administering calcium gluconate

Answer 2

Digoxin

Ca gluconate may precipitate myocardial digoxin toxicity

10 ml of calcium gluconate 10% solution should be mixed with 100ml of glucose 5% and administered slowly over 20 minutes.