Wk 9: Urea + electrolytes (Potassium) Flashcards
What are the causes of hyperkalaemia?
- Renal
- DKA
- Severe tissue damage
- Diet
What are the risks that can produce pseudohyperkalemia?
- Delay sample reaching lab
- Contamination
- Haemolysis
- Drip arm
What are the signs of hyperkalemia?
- Muscle weakness
- Abnormal cardiac conductions (chest pain, ECG changes + cardiac arrest)
What is the 5 step approach in hospital management for hyperkalaemia?
- Protect heart
- Shift potassium into cells
- Remove potassium from body
- Monitoring
- Prevention
What is given to protect the heart (step 1 - hyperkalaemia)?
ECG changes:
- 30ml of 10% calcium gluconate IV
- 10ml of 10% calcium chloride IV
- NB: digoxin patients
What is given to shift potassium into cells (step 2 - hyperkalaemia)?
- Insulin glucose infusion: 10 units of soluble insulin in 250ml dextrose 10%
- 10-20mg salbutamol nebuliser (adjunct)
How long does step 2 last until potassium starts to leak back into extracellular space?
2-6 hours
What is given to remove potassium (step 3 - hyperkalaemia)?
- Potassium exchange polymers
- Anion exchange resin: calcium resonium 15g TDS
- Potassium binders: patiromer calcium or lokelma
- Dialysis
How is hyperkalemia monitored in step 4?
- Continuous cardiac monitoring where ECG fts present
- Potassium every 2-4hrs
- Blood glucose: 15, 30, 60, 90, 120 mins + 6 hrs post dose
What occurs in step 5 of hospital management of hyperkalaemia?
Stop nephrotoxic meds that contribute to hyperkalaemia
What are the signs + symptoms of hypokalaemia?
- Hypotonia
- Cardiac arrhythmias
- Muscle weakness
- Fatigue
- Confusion
- Paralytic ileus
What are some drugs that cause hypokalaemia?
- Salbutamol
- Thiazide diuretics
- Loop diuretics
- Insulin
- Steroids
- Chronic laxatives abuse
What is the management of mild + moderate hypokalaemia?
Oral replacement:
- SandoK:1–2 tabs TDS
- Kay-Cee-L: 10ml–20ml TDS
- SlowK: avoid where possible
What is the management for severe hypokalaemia?
IV replacement w/ continuous cardiac monitoring
What are the risk of hypokalaemia in digoxin patients?
Inc digoxin toxicity - digoxin competes w/ K ions at binding site tf low K = toxicity
