Case in the spotlight 1 - Answers

This ECG demonstrates hyperkalaemia – as demonstrated by the broad irregular complexes and no p waves, rhythm hard to determine

·         Differential diagnosis includes ischaemia and overdose

What will you do?

Does the patient meet MET criteria?

Do I need to call for help?

Ensure the patient has cardiac monitoring

Urgent point of care K+ - do not wait for a lab test which is much slower

Treat early- Bizarre ECG = Bicarbonate.

Early treatment of bicarb 1mmol/kg.

In our institution the renal physician will expect to be involved early, same for ICU

Treatment options include

Calcium chloride: Reduces the risk of ventricular fibrillation caused by hyperkalemia

Insulin administered with glucose: Facilitates the uptake of glucose into the cell, which brings potassium with it.

Na HCO3: Increases the pH, which results in a temporary potassium shift from the extracellular to the intracellular environment; these agents enhance the effectiveness of insulin in patients with academia.

The following have a much slower onset of action

Beta2-adrenergic agonists: Promote cellular reuptake of potassium

Diuretics: Cause potassium loss through the kidney

Binding resins: Promote the exchange of potassium for sodium in the gastrointestinal (GI) system

Magnesium sulfate: Has been successfully used to treat acute overdose of slow-release oral potassium

Further reading

http://emedicine.medscape.com/article/766479-overview