Hyperkalemia

Question 1

Normal range of serum K+

Answer 1

3.5 – 5.1mmol/L

Question 2

When to repeat Sr. K test frequently

Answer 2

If it is >6.0mmol/l or keep on persistently raising

Question 3

Causes of hyperkalemia

Answer 3

Renal failure
Drugs(Spironolactone, ACEI ,NSAID)
Addison’s disease
Rhabdomyolysis
Digoxin

Question 4

Clinical features of hyperkalemia

Answer 4

Muscle weakness
Bradycardia
Arrythmia – Palpitations
Hypotension
Asystolic cardiac arrest
Paresthesia

Question 5

ECG changes in hyperkalemia

Answer 5

Tall tented T waves
Flattened “P” wave
Increased or widened QRS complex
Sine wave pattern - late finding

Question 6

Dx step fro ECG for hyperkalemia

Answer 6

Tall Tented T waves

Question 7

Mx of hyperkalemia steps - to reduce the serum K levels

Answer 7

 Admit
 Keep in the Acute side bed and check A,B,C
 Connect with cardiac monitor and continuously monitor the ECG
 Get an IV access and take blood for – S.Cr, BU, CBS, ABG(metabolic acidosis)
 Give 10ml of 10% Ca gluconate over 10 minutes (Ca gluconate is a cardiac membrane
stabilizer, it raises the threshold of the membranes but it does not change the K+ level
 Give salbutamol nebulization 5mg (actually salbutamol act on the B receptors and enhance
the K+ entry into the cells)
 Give 10 units of soluble insulin with 50ml of 50% dextrose over 30 minutes (this also
increase the K+ entry into the cells)

Question 8

Mx of hyperkalemia to reduce the total body K+

Answer 8

a. K+ binding resins – calbind
b. Lactulose - is an laxative so it will produce diarrhoea and K+ will be lost in
stools(mucus contains a lot of K+ )
c. K+ loosing diuretics (loop diuretics , thiazides)
d. Haemodialysis – the definitive management

Question 9

Effect of cal gluconate on hyperkalemia

Answer 9

cardiac membrane stabilizer. It doesn’t reduce the K+ level

Question 10

Effect of soluble insulin on hyperkalemia

Answer 10

increases influx of K+ into cells

Question 11

why is dextrose is given for the Mx of hyperkalemia along with insulin

Answer 11

to prevent hypoglycemia

Question 12

effect of salbutamol on hyperkalemia

Answer 12

increases K+ influx to cells

Question 13

Wide QRS complex

Answer 13

> 3 squares

Question 14

Patient comes with a snake bite. Sr. K+ is 6.2 mmol/L. ECG shows tall T waves. Immediate Mx

Answer 14

Calcium gluconate. (Heart involvement. Need to stabilize the heart)

Question 15

Patient comes with a snake bite. Sr.K+ 5.9mmol/L. ECG appears normal. Immediate Mx

Answer 15

Insulin + dextrose (cal gluconate can be skipped because heart is not affected)

Question 16

Patient comes with a K+ levels of 7mmol/L. No mention of ECG. Immediate Mx

Answer 16

Cal gluconate