Hyperkalaemia

Question 1

Hyperkalaemia Classification

Answer 1

• Mild 5.5-5.9
• Moderate 6.0-6.4
• Severe >6.5

Question 2

Hyperkalaemia Four Broad Causes

Answer 2

Renal, increased circulation of K (exo/endogenous), shift from intracellular to extracellular (DKA), pseudohyperkalaemia

Question 3

Hyperkalaemia Epidemiology

Answer 3

Extremes of life, male gender (hypokalaemia more common in women)

Question 4

Hyperkalaemia Aetiology

Answer 4

CKD, AKI (90% K secretion is renal), medication (amiloride, spironolactone, ACEi, AIIRAs, NSAIDS)
Exogenous- supplementation
Endogenous- tumour lysis syndrome, crush syndrome, massive tissue damage

Question 5

Hyperkalaemia Special Caveats

Answer 5

Dehydration, diabetes

Question 6

Hyperkalaemia Presentation

Answer 6

Nonspecific, weakness, fatigue, palpitations, chest pain
Few signs, bradycardia, muscle weakness, depressed or absent tendon reflexes
-Physical exam unlikely to suggest diagnosis

Question 7

Hyperkalaemia Ix

Answer 7

Bloods, FBC for anaemia (haemolysis), glucose, ABG, urine

Question 8

Hyperkalaemia ECG

Answer 8

Peaked T-waves, prolonged PR, wide QRS, reduction/loss of P wave, AV dissociation, sine wave pattern, asystole

Question 9

Hyperkalaemia Management

Answer 9

ABG gives instant result

• Determine severity
• Calcium chloride/gluconate (cardioprotection)
• IV insulin with glucose (monitor for hypoglycaemia)
• Salbutamol high dose
• Correct pathology