Emergencies

Question 1

What dose and route of adrenaline should be prescribed in acute anaphylaxis in an adult?

Answer 1

500 micrograms IM

Question 2

Electrolyte disturbances

What are the symptoms and complications of hypokalaemia?

Answer 2

Muscle weakness
Cramps
Fatigue
Constipation
Palpitations
Complications: heart arrhythmias and cardiac arrest

Question 3

Electrolyte disturbances

What concentration of potassium is classed as hypokalaemia?

Answer 3

<3.5mmol/litre

Question 4

Electrolyte disturbances

What drugs may cause hypokalaemia?

Answer 4

Laxatives
Glucocorticoids (e.g., prednisolone)
Insulin
Loop diuretics (e.g., furosemide)
Salbutamol
Some antibiotics (e.g., gentamicin, amphotericin)
Thiazide diuretics (e.g., bedroflumethiazide)
Theophylline

Question 5

Electrolyte disturbances

What are the non-drug causes of hypokalaemia?

Answer 5

GI losses (diarrhoea, eating disorders, vomiting)
Metabolic alkalosis (e.g., low magnesium)
Mineralocorticoid excess (e.g., Cushing’s disease)
Excessive alcohol consumption
Renal tubular acidosis

Question 6

Electrolyte disturbances

What is the maximum rate of infusion of potassium chloride?

Answer 6

10mmol/hr (up to 20mmol/hr in emergencies)

Question 7

Electrolyte disturbances

What concentration of potassium is classed as hyperkalaemia?

Answer 7

> 5.3mmol/l
6.5mmol/l is severe

Question 8

Electrolyte disturbances

What are the symptoms and complications of hyperkalaemia?

Answer 8

Nausea
Muscle weakness
ECG changes (tall tented T waves)
Ventricular fibrillation
Cardiac arrest

Question 9

Electrolyte disturbances

What drugs may cause hyperkalaemia?

Answer 9

ACE inhibitors (e.g., ramipril, lisinopril)
Digoxin
Angiotensin-II receptor blockers (e.g., losartan, candesartan)
Heparin and LMWH
NSAIDs
Penicillins
Potassium sparing diuretics (e.g., spironolactone)
Potassium supplementation
Trimethoprim

Question 10

Electrolyte disturbances

What are the non-drug causes of hyperkalaemia?

Answer 10

Excessive dietary intake
Metabolic acidosis
Renal failure
Rhabdomyolisis
Burns
Trauma

Question 11

Electrolyte disturbances

What is the management of hyperkalaemia?

Answer 11

Stop any drugs causing it

If potassium >6.5mmol/l OR ECG changes present –> IV calcium gluconate (10ml of 10% solution over 3-5mins)

Glucose + insulin IV (5-10 units soluble insulin e.g., Actrapid + 50ml glucose 50%, give over 5-15 mins)

Salbutamol 10-20mg nebulised

Calcium resonium (15g TDS orally) or sodium zirconium cyclosilicate (10g TDS for 72hrs)

If severe, consider dialysis