GIM Question 4 Instructor

A patient on your ward has a serum [K+] of 6.4.

  1. 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
    • Medications
    • 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.

Subscribe to Pearls

Uncle Sam wants you to subscribe to Medical Pearls

Subscribe today! It’s always free, and you can easily unsubscribe at any time. We will never share your email address. Subscribe to...

Multiple Pearls
Cardiology Pearls
Endocrinology Pearls
Hematology Pearls
Nephrology Pearls
Rheumatology Pearls
Transplant Pearls
General Internal Medicine Pearls
Instructor Pearls

Subscribe to receive your pearls today—it's free!