Hyper/Hypokalaemia

Question 1

ECG changes seen with hyperkalaemia?

Answer 1

1. Tall tented T waves
2. Flattened P waves
3. Prolonged PR interval
4. Widened QRS

Question 2

Conditions that can cause hyperkalemia?

Answer 2

AKI
CKD
Rhabdomyolysis
Adrenal insufficiency

Question 3

Medications that can cause hyperkalemia?

Answer 3

Aldosterone antagonists (spironalactone)
ACE inhibitors
ARBs 
NSAIDs
Potassium supplements

Question 4

How to manage mild hyperkalemia (K <6)?

Answer 4

If patient stable and no ECG changes then:

Change in diet
Stop medications that may be underlying cause.

Question 5

How to manage hyperkalemia when K >6 and ECG changes?

Answer 5

Insulin + dextrose infusion:
Drives carbs into cells and takes potassium with it.

Calcium gluconate: stabilises cardiac muscle.

Consider:
Nebulised salbutamol to temporarily drive K into cells
IV fluids to increase urine output.
Dialysis

Question 6

Caused of hypokalemia?

Answer 6

Diuretics
Endorine: cushing's hyperaldosteronism
Hypomagnesaemia
Inadequate oral intake
Gut losses
Insulin

Question 7

How to manage mild hypokalemia?

Answer 7

Oral slow release potassium chloride.

Treat underlying cause.

Question 8

How to manage severe hypokalemia?

Answer 8

Continuous cardiac monitoring.
Check and correct Mg.

IV infusion of 0.9% saline containing potassium chloride.