Hyperkalaemia

Pathology

Raised blood potassium concentration >5.5mmol/L

Aetiology

Increased production: Excess potassium therapy, blood transfusion

Decreased excretion: Renal failure, hypoaldosteronism, Addison’s disease

Release from cells: DKA, metabolic acidosis, burns, rhabdomyolysis

Drugs: Potassium sparing diuretics, Beta blockers, ACE inhibitors, NSAIDS, Potassium supplements

Signs

Ventricular Fibrillation, Kussmaul’s breathing

Symptoms

Non-specific e.g. nausea, malaise, muscle weakness.

Investigations

Bloods: FBC, U+E’s

ECG: decreased P wave amplitude, tall tented T waves, widening of QRS complex

ABG: May show acidosis

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Treatment

Treat underlying cause

K+ of >6.5 and any degree of hyperkalaemia with ECG changes - urgent treatment

Stabilise Myocardium: 10ml 10% IV calcium gluconate

To lower K+: 10 units of Insulin in 50mls 50% Dextrose, Salbutamol nebuliser

Calcium Resonium. Haemodialysis in severe cases

Prognosis

Depends on aetiology

Sudden death

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