Hyperkalaemia

Question 1

You receive a call from the surgical ward about a patient who is 2 days post small bowel resection for adhesions and ischaemic gut. You are told the patient is looking well but their blood tests show a potassium of 6.5 mmol/L (NR < 5.5 mmol/L). How would you manage this?

Imp/DDx/Goals

Answer 1

Impression
This is post-operative hyperkalaemia. Concerning and requires immediate assessment + management to prevent life-threatening complications. There are a number of potential underlying causes including increased uptake, AKI, metabolic acidosis, underlying medical condition (CKD), increased cell turnover (rhabdo, Tumour lysis, etc).

• consider whether pseudohyperkalaemia due to haemolysis or incorrect blood collection (tourniquet on for too long).

Goals

• initiate emergent an ongoing treatment to prevent complications of hyperkalaemia
• identify underlying cause and initiate appropriate treatment

Question 2

Hyperkalaemia - Assessment

Answer 2

Assessment
Approach would be to take A to E approach
- call for help, escalate care (ICU, med reg), MERT call if unstable
A - patent, maintaining
B - Sats, RR - supplemental
C - IV access, BP monitoring, initial bloods (VBG, etc), bedside ECG - look for changes suggestive ofK+ (BLoPPS)
- membrane stabilisation: calcium gluconate
- shift K intracellularly: salbutamol, HCO3, insulin-dex
- increase excretion: diuretics, PR resonium, dialysis
D
E
F

Question 3

Hyperkalaemia - History

Answer 3

History

• sx: muscle fatigue, palpitations, chest pain etc
• risk factors: kidney disease, malignancy, other drugs (B Blockers, ACE-i, diuretics etc)
• PMHx: recent surgery, treatments: read medical chart and recent notes
• Medications

Question 4

Hyperkalaemia - Examination

Answer 4

Exam

• General obs + vitals
• Cardiorespiratory examination
• Fluid balance - AKI assessment

Question 5

Hyperkalaemia - Management

Answer 5

Management:
Following emergent management and consultation with renal/ICU physicians, consider ongoing supportive and long-term measures to prevent relapse and further complications:

Supportive
- correct volume depletion

Definitive

• Renal consult for kidney disease management
• Corticosteroid treatment if hypoaldosteronism
• medications review