Hyperkalaemia

As a junior doctor you will encounter lots of patients with hyperkalaemia. This brief lecture explains all.

 

Lecture by

Video Duration: 7 minutes

  • Hyperkalaemia
    Created by Dr Ed Wallitt
    General
    Epidemiology

    Serum potassium > 5mmol/l

    Divided into:

    • Mild (5-6mmol/l)
    • Severe (>6mmol/l +- ECG changes)
    Pathology

    Potassium release

    • Cellular shifts e.g. acidosis
    • Cellular release e.g. haemolysis, rhabdomyolysis

    Potassium retention

    • Renal failure
    • Potassium sparing diuretics


    Top three causes

    Renal failure

    Drugs (potassium sparing diuretics, NSAIDs)

    Clinical Features
    Symptoms

    None

    Signs

    None

    Investigations
    Cultures

    Urine dip and MC&S if positive

    Bloods

    ABG (? acidosis)

    U&Es (always repeat, ? renal failure)

    Imaging

    None

    Scopic/Biopsy

    None

    Functional

    ECG (looking for classical changes)

    Treatment
    Conservative

    Always repeat the sample! (haemolysis in tube)

    Medical

    Mild

    • Continue monitoring and restrict K fluids and drugs

    Severe

    • Protect myocardium (10ml 10% calcium gluconate IV)
    • Remove potassium (actrapid + dextrose, calcium resonium, salbutamol)


    If refractory may need to consider dialysis

    Surgical

    None