RRAPID HYPERKAELEMIA

Question 1

What is hyperkaelemia?

Answer 1

serum potassium > 5.5mmol/L

Question 2

What ECG changes are seen? (4)

Answer 2

1. tall tented T waves
2. small P waves
3. wide QRS complexes becoming sinusoidal
4. VF

Question 3

Causes (9)

Answer 3

1. AKI
2. potassium sparing drugs
   - amiloride
   - spirolanatone
3. ACE I’s
4. rhabdomyolysis
5. metabolic acidosis
6. iatrogenic
   - excessive potassium infusion
7. addison’s disease
8. massive blood transfusion
9. artefact - haemodialysis

Question 4

Complications (2)

Answer 4

1. death

2. cardiac arrhythmias

Question 5

ABCDE (5)

Answer 5

1. IV access
2. bloods
3. ECG
4. BP
5. O2 stats

Question 6

Treatment (5)

Answer 6

1. calcium gluconate
   - 10%
   - 30mls
   - IV
   - over 2 minutes

or

2. calcium cholride
   - 10%, 10mls over 5-10 mins
   * repeat the dose if there are no improvements on ECG after 5-10 mins
3. insulin and glucose

• 50mls of 50% glucose IV
• over 10 minutes

or

• 120 ml 20% glucose

WITH

• soluble insulin 10 units IV over 5-10 mins
  4. salbutamol
• 10mg-20mg nebulisers

or

• 5mg back to back over 10-20 mins
  5. calcium resonium
• 15g orally every 6-8 hours

Question 7

Other measures? (3)

Answer 7

1. potassium in diet
2. review medications
3. renal replacement tehrapy