hyperkalaemia

Question 1

define hyperkalaemia

Answer 1

> 5.5mmol/L

Question 2

causes of hyperkalaemia

Answer 2

kidney disease (AKI, CKD)

drugs

rhabdomyolysis

metabolic acidosis

endocrine disorders

haemolysis

Question 3

drugs causing hyperkalaemia

Answer 3

drugs that reduce K+ excetion - K+ sparing diuretics and ACEi

nephrotoxic drugs - NSAIDS

K+ supplements - fluids and added K+ and feed

Question 4

endocrine disorders causing hyperkalaemia

Answer 4

addisons disease

diabetic ketoacidosis

Question 5

rating of hyperkalaemia

Answer 5

into mild, moderate and severe

Question 6

what bloods to do in ? hyperkalaemia

Answer 6

FBC, U+Es, LFTs, VBG

Question 7

investigation in C very important in hyperkalaemia

Answer 7

ECG

Question 8

changes in ECG of hyperkalaemi

Answer 8

flattened P wavfes
TTTW
S and T wave merging
widened QRS
tahcy/brady
cardiac arrest

Question 9

if ECG abnormalities?

Answer 9

attach patient to cardiac monitoring

Question 10

management of mild hyperkalaemia

Answer 10

remove cause

monitor

Question 11

management of moderate hyperkalaemia

Answer 11

treatment guided by clinical case and presence of ECG changes

Question 12

management of severe hyperkalaemia

Answer 12

emergency treatment required

Question 13

pharacological treatment of hyperkalaemia

Answer 13

calcium chloride to stabilise myocardium

insulin and nebulised salbutamol to move K+ into cells

calcium resonium considered to remove K+ from body

Question 14

calcium chloride for hyperkalaemia

Answer 14

30ml 10% IV

or

10ml 10% over 5-10min

change in ECG after 3min, if not repeated after 5-10min

Question 15

insulin for hyperkalaemia

Answer 15

10units soluble Insulin with 50ml of 50% gluocse via syringe drive over 15min

Question 16

salbutamol for hyperkalaemia

Answer 16

5mg nebulised

Question 17

calcium resonium for hyperkalaemia

Answer 17

15g orally

Question 18

referalls for hyperkalaemia

Answer 18

Discuss with senior member of the team

Contact critical care outreach team

Referral to renal team if K+ > 6.5 mmol/L despite medical management. Patient may require dialysis

Consider referral to Intensive Care Unit (ICU)

Question 19

when to consider ICU referral in hyperkalaemia

Answer 19

Failure to respond to medical management

Patient requires cardiac monitoring

Patient requires blood pressure support

Deterioration of blood gas following medical management

Question 20

further management of hyperkalaemia

Answer 20

ensure regular perscriptions are reviewed