A patient on your ward has a serum [K+] of 6.4.
- Outline the steps you would take to manage her hyperkalemia.
Management of hyperkalemia involves:
- Ensure the value is not spurious – check pre-existing K+ values if available to compare. Repeat electrolytes if there is time (i.e. no ECG changes)
- ECG – check for changes that reflect hyperkalemic effects on the myocardium
- Tented and peaked T waves
- Flattening/absent P waves
- Widening of the QRS
- Sine waves
- Calcium gluconate 1g IV – administer if ECG changes are present to protect the myocardium and avoid cardiac dysregulation.
- Insulin 10U IV with dextrose 12.5-25g – insulin promotes the shifting of potassium into cells, thereby lowering serum [K+]. Glucose administration is to protect against hypoglycaemia with insulin. Accucheck for blood glucose first.
- Salbutamol 10mg nebulized – β2-agonists can be used as an alternative to insulin to shift K+ intracellularly. It can also be used with insulin in cases of severe hyperkalemia.
- Repeat electrolytes in 1-2 hours to ensure there is a change in K+ with treatment
- Search for an underlying cause of hyperkalemia:
- Renal failure
- Urinary obstruction
- Exogenous intake (supplements/diet)
Elliot ME, Ronksley PE, Clase CM, Ahmed SB and Hemmelgarn BR. Management of patients with acute hyperkalemia. CMAJ. 182:1631-1635.
Nyirenda M, Tang JI, Padfield PL and Seckl JR. Hyperkalaemia. BMJ. 2009, 339:1019-1024.