Hyperkalaemia

Causes

• Renal failure
• Diabetic ketoacidosis
• Excessive potassium therapy
• Potassium sparing diuretics - spironolactone, amiloride etc
• Metabolic acidosis
• Severe tissue damage
• Massive blood transfusion

Signs and symptoms

• Cardiac arrhythmias, sudden death,
• Abnormal ECG, tall T wave, widen QRS, small p wave

Treatment

• Consult senior help if required
• Optimise fluid balance
• Treat sepsis
• 10-30 ml of calcium gluconate (10%) for cardio-protection
• 10 units soluble insulin with 50 ml 50% dextrose IV over 15-30 minutes. Monitor blood glucose.
• Polystyrene sulphonate resin i.e. Calcium resonium 30 g PO or PR. This increases gut losses of potassium. Takes 24 hours to work
• Monitor serum potassium frequently to assess response. Patient may require dialysis, consult nephrologist