Renal - Hyperkalaemia

Question 1

What is the main complication of hyperkalaemia?

Answer 1

Cardiac arrhythmias e.g. ventricular fibrillation

Question 2

Complete the table

Answer 2

Question 3

What conditions can cause hyperkalaemia?

Answer 3

AKI
CKD (Stage 4 or 5)
Rhabdomyolysis
Adrenal insufficiency
Tumour lysis syndrome

Question 4

What medications can cause hyperkalaemia?

Answer 4

Spironolactone
Eplerenone
ACEi
ARBs
NSAIDs

Question 5

What can cause psuedohyperkalaemia?

Answer 5

Haemolysis during sampling causing falsely elevated potassium

Repeat sample

Question 6

What ECG changes are seen with hyperkalaemia?

Answer 6

Tall peaked T-waves
Flattening or absence of P waves
Prolonged PR interval
Broad QRS complexes

Question 7

How is hyperkalaemia managed in patients with no ECG changes + under 6.5mmol/L?

Answer 7

Treat underlying cause
Treat AKI
Stop spironolactone or ACEi

Question 8

When do patients require urgent treatment for hyperkalaemia?

Answer 8

ECG changes
Serum potassium over 6.5mmol/L

Question 9

What is the golden standard treatment of hyperkalaemia?

Answer 9

Insulin + dextrose infusion

IV calcium gluconate

Insulin- drives potassium from extracellular space to intracellular space

Dextrose- prevent hypoglycaemia while on insulin

Calcium gluconate- stabilises cardiac muscle cells and reduces risk of arrhythmias

Question 10

What other options are available for lowering serum potassium?

Answer 10

Nebulised salbutamol
Temporarily drives potassium into cells

Oral calcium resonium
Reduces potassium absorption in GI tract, slow and causes constipation

Sodium bicarbonate
(acidotic patients) drives potassium into cells as it corrects acidosis

Haemodialysis
Severe or persistent cases