Hyperkalaemia Flashcards
What is classified as Hyperkalaemia? What are the different stages?
Different definitons available
- Mild hyperkalaemia: 5.5 to 5.9 mmol/L (5.5 to 5.9 mEq/L)
- Moderate hyperkalaemia: 6.0 to 6.4 mmol/L (6.0 to 6.4 mEq/L)
- Severe hyperkalaemia: ≥6.5 mmol/L (≥6.5 mEq/L).
Classification system that also takes into account ECG changes
What can be classified as potentially life-threatening features in hyperkalaemia?
Always depends on context and subjective judgement but some features inclue
- Potassium >6.5 mmol/L
- Moderate hyperkalaemia (>6mmol/L ) and clinically unwell/ rapid rise in potassium
- ECG changes
- bradycardia and shock
- clinical signs and symptoms of hyperkalaemia (flaccid muscle paralysis, muscle weakness)
What ECG changes can be seen in hyperkalaemia?
In natural progression:
- tall peaked T waves
- shortened QT interval,
- ST segment depression
- prolonged PR interval
- disappearing P wave
- widening of QRS (progressive QRS widening may be seen with higher levels of hyperkalaemia)
- amplified R wave
- arrhythmias (atrial fibrillation, bradycardia, ventricular tachycardia)
What is the indication for administration of calcium gluconate in hyperkalaemia?
In all patients with ECG changes, inlcuding arrythmias
Usually Calcium gluconate 10ml of 10% (duration of effect of calcium is between 30 and 60 minutes)
What should be the treatment for hyperkalaemia with life-threatening features?
1.Calcium gluconate if ECG changes
2. Insulin + glucose
2. Salbutamol
3. Investigate cause
If acutely life-threatening, renal disease, rapidly rising (e.g. rhabdomyalisi) or refractory: haemodyalsis for Hyperkalaemia
What should be the treatment of hyperkalaemia witout life-threatening features?
- treatment of underlying cause
- Consider: cation-exchange resin/polymers, diuretics, sodium bicarbonate or dialysis
