![]() ![]() The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. The cookie is used to store the user consent for the cookies in the category "Performance". This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other. The cookies is used to store the user consent for the cookies in the category "Necessary". The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". The cookie is used to store the user consent for the cookies in the category "Analytics". These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly. Subsequent Ventricular Fibrillation (VF) or asystole may then follow. The progressively widened QRS eventually merges with the T wave, forming a sine wave pattern. Progressive widening of the QRS complex.Tall ‘tented’ T waves (seen across the precordial leads).1), potentially life-threatening arrhythmias can occur without warning in hyperkalaemia. ![]() ![]() Whilst the ECG findings generally can be correlated to the serum potassium concentration (Fig. The ECG is vital in the assessment of hyperkalaemia, as ECG findings will progress with increasing serum levels. Figure 1 - ECG findings in the precordial leads in hyperkalaemia The patients observations and fluid status should be reviewed, as well as their medication (identifying any precipitants of hyperkalaemia). Catheterisation, if necessary (for fluid balance monitoring).A VBG will provide an immediate result of the patient's potassium levels.Routine bloods, including U&Es, Ca 2+ and PO 4 2-, and Mg 2+.The assessment of any patient with hyperkalaemia needs to be timely and is often performed simultaneously with treatment. Potassium-Sparing Diuretics, including SpironolactoneĪ patient may commonly be asymptomatic symptoms are rare in patients with a potassium serum concentration of less than 7.0mmol/l.Īny symptoms of hyperkalaemia that may present include paraesthesia, muscle weakness, nausea and vomiting, and palpitations.The most common causes of hyperkalaemia in the post-operative patient are: Whilst usually asymptomatic at relatively low levels, it is important to identify and treat the condition early due to cardiac and other complications that may arise. Hyperkalaemia is defined as an elevated serum potassium, greater than 5.5 mmol/l (may vary depending on local reference ranges) *Oral calcium resonium can be used to reduce total body potassium, reabsorbing potassium into the bowel intra-luminally, however this step is complex and specialist input should be sought early. Referral to renal physicians may be warranted in cases of severe hyperkalaemia or resistant hyperkalaemia potentially warranting haemodialysis. Reduction of Total Body PotassiumĪny reversible underlying cause should be identified and appropriately managed*. Salbutamol nebulisers may also be additionally added in for further (albeit limited) reduction. These measures are only short term, as the potassium will leave the cells within 30-60 minutes, therefore repeated doses may be required. Variable rate insulin with dextrose infusion should be started (typically 200ml of 20% glucose with 10U of insulin over 30mins, yet varies with local policy), acting to increase cellular uptake of potassium and thus reduce serum concentration. Stabilisation of the MyocardiumĪ stat dose of intravenous Calcium Gluconate or Calcium Chloride (typically 10ml of 10%, dependent on local guidelines) should be started, either when ECG changes are present or in all cases of moderate or severe hyperkalaemiaĬontinuous cardiac monitoring is required following stabilisation treatment in such cases. ![]() Alert a senior to any complications developing. Whilst the rationale for the first and second management strategies may be self-evident, it is important to consider that the underlying cause for the hyperkalaemia must also be addressed.Įarly and repeated blood testing is vital and any ECG changes warrant urgent treatment and moving the patient to a high-dependency area. The management of a hyperkalaemic patient can be considered in three parts: ![]()
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