Definition

serum potassium more than 5.0 mEq/L.

Hyperkalemia causes

> Renal failure, type 4 Renal tubular acidosis

> Pseudohyperkalemia- leakage from erythrocyte when processing of serum from clot is delayed

> Overdose of potassium supplementation

> hypokalemic periodic paralysis, insulin deficiency

> Adison disease

> Shift potassium extracellularly- Acidosis, Rhabdomyolysis, severe infection, haemolysis, burn, internal bleeding, vigorous exercise, etc

> Drugs

1. Potassium sparing diuretics, 2. ACE Inhibitors, 3. Beta blockers, 4. Combinations of above drugs, spironolactone, eplerenone, NSAIDS triamterene, cyclosporine etc.

Clinical feature- Hyperkalemia symptoms and Signs

Muscle weakness, ileus flaccid paralysis, fatigue, dizziness

Hyperkalemia Diagnosis

Serum potassium more than 5.0 mEq/L.

ECG changes

(May not always parallel serum potassium levels)

— Tall and peaked T waves (> 5.5mEq/L)

— Wide QRS complex (> 6.0mEq/L.)

— Absent P wave (> 7mEq/L)

— Sine wave indicates imminent ventricular standstill, ventricular fibrillation and Cardiac Arrest- terminal (> 8.0mEq/L)

Hyperkalemia Treatment:

1. Stop all potassium containing food and fluids. (Fruits, tender coconut water, fresh vegetables and coffee)

2. Stop all medications that can increase potassium

4. In Mild hyperkalemia ( serum K+ 5- 6mEq/L) Correct acidosis- Tablet Sodium bicarbonate 500 mg TID, K- bind sachet 1/3 rd od, tab. Frusemide 40 mg sos

5. In Moderate hyperkalaemia (K of 6-8mEgL) and ECG does mot show any abnormality othe than tall T waves.

continue all of the above treatment, 50 ml of 50% glucose IV wih 8 units of regular insulin or

8 units of plai insulin in 500ml 5%D IV over 6 hours, in no urgency

Insulin shift potassium from extracellular to intracellular is the fastest way

100 ml 8.4% Sodium bicarbonate over 15minutes can be given instead. If calcinem gluconate needs to be given then Sodium bicarbonate in better avoided as can bind to calcium
Beta2 agonist nebulization- salbutamol Q6 hourly

6. In Severe hyperkalaemia (serum K>8 mEgL)

To reverse the cardiac effects of K give 10ml 10% calcium gluconate IV over 10minutes with monitoring of ECG.
Repeat calcium gluconate dose if there is no response after 5 minutes.
continue all of the above treatment
Still, if there is no response consider Dialysis for resistant life-threatening hyperkalemia.

Treatment of Hypermagnasaemia

(symptomatic) > 3mg%

10ml 10% calcium gluconate in 100ml 5%D over 30 minutes
Inj. Frusemide 40-80mg IV 6 hourly
Haemodialysis in the presence of renal failure