Hyperkalaemia

Question 1

Causes of hyperkalaemia

Answer 1

• Conditions
  
  • AKI
  • CKD
  • Rhabdomyolysis
  • Adrenal insufficiency
  • Tumour lysis syndrome
• Medications
  
  • Aldosterone antagonists (spironolactone and eplerenone)
  • ACE-I
  • ARBs
  • NSAIDs
  • Potassium supplements

Question 2

Presentation of hyperkalaemia

Answer 2

• Perioral tingling and paraesthesia
• Arrhythmias
• Asymptomatic

Question 3

Investigation of hyperkalaemia

Answer 3

• U&Es (AKI)
• ECG
  
  • Tall peaked T waves
  • Flattening or absence of P waves
  • Broad QRS complexes

Question 4

Management of hyperkalaemia (mild - 5.5-6.5mmol/l)

Answer 4

• Assess fluid status
• IV fluids
• Fluid balance
• Stop any exacerbating medications
• Consider calcium resonium - only licenced for hyperkalaemia due to anuria or oliguria

Question 5

Management of hyperkalaemia (moderate/severe - >6.5mmol/l or ECG changes)

Answer 5

• 10mls of 10% calcium gluconate over 10 minutes
• Insulin (Actrapid) in 100mls of IV glucose over 30 minutes
• Nebulised salbutamol
• Repeat K 30 minutes post insulin/dextrose