Hyperkalaemia (GO…)

Question 1

Definition

Answer 1

> 5.5 mmol/L
6.5 mmol/L = EMERGANCY

Question 2

What is Acute self-limiting hyperkalaemia

Answer 2

Acute self-limiting hyperkalaemia happens normally after vigorous exercise + is of non-pathological significance

Question 3

Risk factors

Answer 3

Impaired excretion:
- AKI or CKD
- Drug effect
- Renal tubular acidosis
Increased intake
- Intravenous therapy
- Increased dietary intake
Shift of Extracellular K+
- Metabolic acidosis
- Rhabdomyolysis

Question 4

Aetiology

Answer 4

AKI (MC)
Drugs - ACE-I with NSAIDS or Potassium sparring diuretic (e.g Ramipril with SPIRONOLACTONE or ibuprofen)
Addisons
DKA (+DM)
Increased intake
Renal tubular acidosis

Question 5

Pathophysiology

Answer 5

K+ in blood determines the excitability of nerve and muscle cells (inc. myocardium)
K+ levels increase = decreases threshold for AP = easier depolarisation = abnormal heart rhythms

Question 6

Symptoms

Answer 6

Fatigue
Generalised weakness
Chest pain
Palpitations

Question 7

Signs

Answer 7

Fast irregular pulse (VF risk)
Myalgia

Question 8

Diagnosis

Answer 8

ECG:
- Absent P waves (GO)
- Prolonged PR interval (GO LONG)
- Tall, tented T waves (GO TALL)
- Wide QRS complex (GO UNDER)
Urine osmolarity, electrolytes (increased K+)
Bloods: FBC, U+E
- Creatinine
- Urea
- eGFR

Question 9

Treatment

Answer 9

ABC assessment + Cardiac monitoring
FIRST CALCIUM GLUCONATE = Protect myocardium
FIRST LINE = Nebulised Salbutamol = Drive K+ intracellularly (for hyperkalaemia with heart problems - palpitations, v tach -> v.fib)
or Insulin + Dextrose (for hyperkalaemia only)