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Endocrinology > Hyper/Hypo - Kalaemia > Flashcards

Hyper/Hypo - Kalaemia Flashcards

1
Q

What is the serum level that defines hyperkalaemia?

A

> 5.5mmol/L

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2
Q

What are some artefactual causes of hyperkalaemia?

When should you consider these?

A
  • Patient clenches fist during blood test
  • Contamination (FBC done before U+E)
  • Thrombocytopenia (K+ leaks out of platelets during clotting)
  • Delayed analysis (K+ leaks out of RBC’s)

Consider these is patient is well and has no symptoms

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3
Q

What are some causes of hyperkalaemia?

A
  • Oliguric renal failure
  • K+ sparing diuretics
  • Rhabdomyolysis
  • Metabolic acidosis (DM)
  • Excess K+ therapy
  • Addison’s Disease
  • Massive blood transfusion
  • Burns
  • Drugs (ACE-i)
  • Artefactual results
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4
Q

What defines moderate hyperkalaemia?

A

6 - 6.4 mmol/L

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5
Q

What defines severe hyperkalaemia?

A

> or equal to 6.5 mmol/L

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6
Q

What is the treatment for hyperkalaemia in non urgent cases?

A
  • Treat underlying cause
  • Review medications
  • Calcium resonium binds K+ in the gut, preventing absorption and brings K+ levels down over a few days
  • Can be given as an enema if not tolerated PO
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7
Q

What signs require emergency treatment for hyperkalaemia?

A
  • Myocardial excitability

- K+ > or equal to 6.5 mmol/L

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8
Q

What is the emergency management for hyperkalaemia?

A
  1. Alert senior
  2. Conduct 12 lead ECG and get IV access, get a VBG and use blood gas analyser
  3. Give calcium gluconate 10% 30ml IV by slow IV push over 5-10 minutes (10ml of calcium chloride if not available). This protects the heart.
  4. 10 units IV soluble insulin in 25g glucose
  5. Nebulised salbutamol 20mg (4 x 5mg back to back)
  6. Consider referral to ITU for haemofiltration, or haemodialysis
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9
Q

What ECG changes occur with hyperkalaemia?

A
  • Tall tented T waves
  • Increased PR interval
  • Small or absent P wave
  • Widened QR complex
  • Sine wave pattern
  • Asystole
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10
Q

What are symptoms of hyperkalaemia?

A
  • Fast irregular pulse
  • Chest pain
  • Weakness
  • Palpitations
  • Lightheadedness
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11
Q

What serum value denotes hypokalaemia requiring urgent treatment?

A

K+ <2.5mmol/L

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12
Q

What are some symptoms of hypokalaemia?

A
  • Muscle weakness
  • Hypotonia
  • Cramps
  • Tetany
  • Palpitations
  • Light headedness (arrythmia)
  • Constipation
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13
Q

What are some ECG changes associated with hypokalaemia?

A
  • Small or inverted T waves
  • Prominent U waves
  • Long PR interval
  • Depressed ST segments
  • Ventricular fibrillation
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14
Q

What are some causes of hypokalaemia?

A
  • Diuretics
  • Vomiting and diarrhoea
  • Pyloric stenosis
  • Rectal villous adenoma
  • Intestinal fistula
  • Cushings syndrome/steroids/ACTH
  • Conns syndrome
  • Alkalosis
  • Renal tubular failure
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15
Q

If on diuretics, what blood result will show that hypokalaemia is longstanding?

A
  • Increased HCO3-
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16
Q

What is the treatment for mild hypokalaemia (3-4)?

A
  • Give oral K+ supplement (Sando-K 2-4 tablets 2-3 times a day)
  • Review K+ after 3 days
  • If taking a thiazide, consider repeating blood results or giving a K+ sparing diuretic
17
Q

What is the treatment for moderate hypokalaemia with arrythmia (2.5-3.5)?

A
  • Continuous ECG monitoring
  • Peripheral K+ (40mmol/L KCL in 1 litre 0.9% saline or 5% dextrose over no faster than 250ml/hr)) Prescribe as potassium chloride 0.3%
  • Do not give if oliguric
  • Never give K+ as a fast stat bolus dose
18
Q

What other electrolyte should you check with hypokalaemia and why?

A
  • Magnesium

- Hypokalaemia is difficult to correct if this is low too

19
Q

What should you suspect in a patient that is hypertensive, with hypokalemic alkalosis in a patient not taking diuretics?

A

Conn’s syndrome

20
Q

What is the treatment for severe hypokalaemia (<2.5) with or without arrythmia?

A
  • You can give 50mmol/50ml of K+ via a CVC. Max rate 20ml/hr
21
Q

What is the prescription for acute replacement of Magnesium?

A

8mmol in 20ml 0.9% saline over 15 minutes

Endocrinology (11 decks)

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