MyCpdZw - Protocols Details

HYPERKALAEMIA

Hyperkalemia is the medical term that describes a potassium level in your blood that's higher than normal. Potassium is a chemical that is critical to the function of nerve and muscle cells, including those in your heart. Your blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L).

Diagnosis

Usually asymptomatic until cardiac toxicity intervenes (arrhythmias, asystole!).

Occasionally presents with muscle weakness, confusion or respiratory paralysis.

All need an ECG.

ECG changes may include:

· Tall, peaked T-waves,

· Widened QRS complexes,

· Increased PR interval,

· Flattened P waves,

· Arrhythmias including asystole, Ventricular Tachycardia & Ventricuar Fibrillation.

Ensure the result is not an artifact from a haemolysed sample.

Causes:

· Increased total body stores:

o Renal failure,

o Hypoaldosteronism 9Addison’s Disease),

o Drugs,

o Excessive intake.

· Redistribution:

o Acidosis,

o Hyperkalaemic period paralysis,

o Rhabdomylisis,

o Heamosis.

· Drug induced:

o Potassium sparing diuretics (Spironolactone, Amiloride),

o Others (NSAID’s, ACE inhibitors, B-blockers, Aspirin).

Usually asymptomatic until cardiac toxicity intervenes (arrhythmias, asystole!).

Occasionally presents with muscle weakness, confusion or respiratory paralysis.

Management

Emergency treatment is required when the serum potassium is >7.0 mmol/1 or if there are ECG changes.

Mild-moderate hyperkalaemia (5.5-7.0 mmol/1):

· Identify & treat the cause as appropriate,

· Avoid potassium sparing or retaining drugs (sse above),

· Consider use of Calcium Resonium & Bicarbonate.

Severe hyperkalaemia (>7.0 mmol/1):

· Identify & treat the cause,

· Stop any potassium infusions or drugs causing potassium retention,

· Monitor closely,

· IV Calcium Gluconate:

o Start without delay. Protects the heart from arrhythmias by stabilizing the

myocardium,

o Has NO EFFECT on the potassium levels,

o 10mLs 10% over minutes,

o Repeat after 5 minutes if ECG changes haven’t improved,

o AVOID in patients on Digoxin (precipitates arrhythmias!). If you do use it administer it slowly & in low doses.

· Calcium Resonium:

o Cation exchange resin that removes excess potassium in exchange for calcium.

o Slow onset of action (2-12 hours),

o Give 15 g orally (or via NGT) QID (0.3-0.6 g/kg in children),

o If unable to use oral route 30 g can be given rectally.

· IV Insulin +/- glucose:

o Drive potassium into the cells,

o 10 units Actrapid Insulin with mLs of 50% glucose over minutes,

o Effective within 30-60 minutes.

· Sodium bicarbonate:

o Encourage movement of potassium into cells,

o Use when acidotic & HCO3 < 29mmol/1,

o 50-100 Mls 4.2% sodium bicarbonate IV,

o Effective within 30-60 minutes, Beware, rapid alkalinisation can cause Tetany by

lowering the ionized calcium.

· Consider Salbutamol, fludrocortisones & dialysis

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