Remember: is it a haemolysed blood sample? (you can do an iSTAT)
Severity
- Mild: 5.5-5.9mmol/l – No urgent action required (Dietary & Medication modification & GP F/U)
- Moderate: 6.0-6.4mmol/l – Follow treatment guide (maybe suitable for discharge)
- Severe: ≥6.5mmol/l OR ECG changes – Follow treatment guide, must admit
Signs/Symptoms
- Muscle weakness
- Constipation
- Arrhythmias
ECG Changes
a.Tented T, b. Prolonged PR, c. Wide QRS
As Potassium (K) rises the arrhythmias can deteriorate
a. Bradycardia & wide QRS
b. & c. Sine wave
d. VT
Treatment pathway
1. Protect the heart
- 6.8mmol Calcium IV is recommended- equivalent to: 10ml Calcium Chloride 10% (6.8mmol Ca) OR 30ml Calcium Gluconate 10% (6.9mmol Ca)
- In Digoxin toxicity Calcium can theoretically potentiate effects, so consider using; slower infusion (30min) OR Magnesium Sulphate 2g I.V. instead of Calcium
2. Move K into cells
- Insulin (Actrapid) 10 unit & 25g of Glucose (250ml 10%, OR 50ml 50%) I.V. (30min)
- Can reduce K by 0.65-1mmol/l
- Must Monitor Blood Glucose for 6hrs (due to risk of hypoglycaemia)
- Salbutamol 10-20mg Neb.
- Can reduce K by 0.62-0.8mmol/l (but can be inconsistent)
- Caution if Hx of Ischaemic Heart Disease or Arrhythmia
- β-Blockers and Digoxin can attenuate effect
- Sodium Bicarbonate 1.4% 500ml I.V. (2hours)
- Only in Acidosis pH <7.2
- This is controversial and must only be given on instruction of senior decision maker
- Never give with Ca (due to risk of precipitation)
3. Remove K from body
- 0.9% NaCl I.V. – this will dilute and improve renal excretion
- Dialysis – Likely to be needed if: K >7.5mmol/l, Oliguric, CRF and on dialysis
- Calcium Resonium – SLOW onset 2-6 hours, Contraindicated in hypercalcaemia
4. Monitor
- ECG monitoring
- U&E’s
- Glucose
5. Prevent recurrence
- Treat cause: Rhabdomyolysis, Haemolysis, Trauma, Renal disease, Low insulin, Low steroid, etc.
- Medication Review: Spironolactone, NSAID, ACEi, Ciclosporin, Digoxin etc.
- Food (see list below)
PDF: full guide from UK renal association (its long)
