K

Question 1

Which electrolytes are we concerned with?

Answer 1

• Ca
• Mg
• K
• Na
• Ph

Question 2

Calcium

Answer 2

2.2-2.6

Question 3

Magnesium

Answer 3

0.6-1

Question 4

Phosphate

Answer 4

0.87-1.45

Question 5

Potassium

Answer 5

3.5-5.3

Question 6

Sodium

Answer 6

113-146

Question 7

K - results

Answer 7

Normal: 3.5 - 5.3 mmol/L
Hyper: >6.5 (you might see changes in ECG)
Нуро: <2.5

Imbalance = cardiac SE e.g. arrythmias

Question 8

In which patients should they take potassium?

Answer 8

1. Digoxin or anti-arrythmic drugs
   - K depletion = arrythmias
2. Secondary hyperaldosteronism
3. Excessive loss of K in faeces
   - Chronic diarrhoea
4. Elderly
5. Drugs that cause K loss
   - CS, diuretics

Question 9

Hyperkalaemia - causes

Answer 9

1. Drugs
2. DKA
3. Renal failure
4. Addison’s disease

Question 10

Hyperkalaemia - symptoms

Answer 10

• Fatigue
• numbness, nausea
• SOB, chest pain, palpitations

Question 11

Hyperkalaemia - drugs

Answer 11

• Trimethoprim
• Heparins
• ACEi / ARBs
• NSAIDs
• K-sparing diuretics
• Ciclosporin, Tacrolimus
• BB

THANKC B

Question 12

Acute Hyperkalaemia - Severe treatment

Answer 12

1. IV calcium chloride 10% / calcium gluconate 10%
2. IV soluble insulin (5-10u)
   - with 50mL Glucose 50% IV
   - given over 5-15 mins
3. Salbutamol (Nebulised or slow IV injection)
   - use with caution in CVD
   - remember, the side-effect of salbutamol is HYPOkalaemia

Question 13

Acute Hyperkalaemia - mild-moderate treatment

Answer 13

4. lon-exchange resins
   - Calcium resonium

Question 14

Hypokalaemia - symptoms

Answer 14

• Muscle weakness, rhabdo
• Hypotonia
• Paralytic ileus
• depression, Confusion
• Arrhythmia, palps

Question 15

Hypokalaemia - causes

Answer 15

1. Drugs
2. Persistent vomiting or diarrhoea
3. Aldosteronism
4. Cushing’s syndrome

Question 16

Hypokalaemia - drugs

Answer 16

• Aminophylline/ theophylline
• B2 agonist e.g. Salbutamol,
  Salmeterol
• CS
• Diuretics - loop, TL
• Erythro/clari
• Insulin

ABCDE I

Question 17

Hypokalaemia - treatment

Answer 17

Mild to moderate - K supplements e.g. Sando-K
Severe - IV KCl in NaCl

Question 18

Hypokalaemia - digoxin

Answer 18

Hypokalaemia predisposes patients taking digoxin to toxicity

Question 19

Hypokalaemia - renal impairment

Answer 19

• K replaced cautiously in patients with renal impairment
• Risk of hyperkalaemia secondary to impaired potassium excretion