see also: [[APLS#paeds hyperkalaemia|APLS → hyperkalaemia]] > [!key points] > - treat the actual serum K+ value, not the value corrected for pH > - treat immediately if ECG changes or K > 7 > - repeat K level 1h post therapy > [!treatment] > - [[Calcium Gluconate]] 10% IV 10 mL (=1g or 2.2 mmol) IV over 2-3 min, repeat up to 60mL > - or calcium chloride 10% 5 mL, repeat to max of 30mL > - *works in minutes , last 30-60 min* > - **resonium** 30g oral or rectal Q 4-6h > - takes hours to have effect , *lasts 4-6 hours* > - **insulin/dextrose** 10 units + 50mL of 50% dextrose > - works in *20-30 min*, *lasts 2-4 hours* > - lowers K ~ 1mmol/L > - esp with chronic renal failure, commence 10% dextrose at 50L/h > - **frusemide** > - **salbutamol** 5 mg nebulised (can give up to 20 but usually better start lower) > - lowers ~1 mmol/L, lasts1-2 hours > - [[HCO3 therapy|HCO3]] 50 mmol (1 mmol/L) over 30 min IV > - most benefit if pt has severe metabolic acidosis > - high doses risk development of fluid overlod in pts with renal impairment > - [[haemodialysis]] # causes - [[Blood gas#calculate expected k for ph|acidosis]] (redistribution) - [[Acute Renal Failure]] - rare ↑ K if Cr <800 micromol/L - K >5.5 uncommon until <90% of renal function lost and eGFR <20 - if Cr < 500, consider adrenal insufficiency as cause of hyper-k - K increases 0.5 mmol/L/day in anuria - [[Adrenal insufficiency]] - [[Massive blood transfusion|blood transfusion]] - haemolysis - GI bleeding - [[rhabdomyolysis]] - increases by 2-4 mmol/L/day when tissue daamage present - [[Digoxin toxicity]] - suxamethonium - hyperthermia - k-sparing diuretics - spironolactone (reduced elimination) - ACE-i - ARBs - trimethoprim - SLE - amyloidosis # physiology ![[Pasted image 20240208090641.png]] ## ECG changes | K mmol/L | ECG changes | | ---- | ---- | | 6-7 | tall peaked T waves | | 7-8 | QRS wide, flattening of p waves | | 8-9 | fusion QRS with T wave → sine wave | | >9 | AV dissociation, VT, VF, heart block, | # symptoms - ECG changes as above - neuromuscular weakness # Paeds hyper-k treatment see also: [[APLS#paeds hyperkalaemia]] - **calcium gluconate** 10% *0.5 mL/kg* (20mL max) or calcium chloride 10% 0.1-0.2mL/kg max 10 mL - insulin actrapid 0.1 units/kg (max 10) AND dexrose 10% 5mL/kg - resonium 0.3 - 1 g/kg pr Q6H - salbutamol # Related Questions ## dialysis - [ ] 2Q: [Lethargy after Missed Dialysis](x-devonthink-item://2504F01B-CEAF-41E8-803B-B3AE1B07A49E?page=1) -- [Answer](x-devonthink-item://00427DF6-6D28-4FEB-A0CA-DF96DBBBCE97?page=21) -- [prop](x-devonthink-item://AB9BDA6D-9CA8-4E73-9D15-B6105225A1B4?page=18) ## hyperkalaemia - [x] 72Q: [Methamphetamine use and electrolyte disturbance](x-devonthink-item://B257662E-D069-4044-AF7A-736487B5CA99?page=8) -- [Answer](x-devonthink-item://1658DB69-4D34-47EF-9495-B6B43E0BE3BE?page=10) - [x] DUPLICATE Q: [Abnormal ECG](x-devonthink-item://7FCD3940-4BB4-45FE-86A6-E5707E82D5B5?page=69) -- [Answer](x-devonthink-item://3263A68A-96A6-43EC-985B-43260C3509BF?page=26) - [ ] 73Q: [HHS](x-devonthink-item://5FC539E5-7F1D-48E5-B062-83009DA98093?page=7) -- [Answer](x-devonthink-item://D25C2F83-6C30-4F45-8B5B-6E7E57BD24A3?page=4) -- [prop](x-devonthink-item://0F9688C6-AA10-45DA-BFF4-9BBBFC201582?page=3) - [ ] 74Q: [Collapse and Hyperkalaemia](x-devonthink-item://3D57C3FE-3B52-42E0-9FBD-E4034F60C5B7?page=16) -- [Answer](x-devonthink-item://75D8E35B-EE77-4D1B-A665-438451C976AE?page=27) - [x] DUPLICATE Q: [Lethargy after Missed Dialysis](x-devonthink-item://2504F01B-CEAF-41E8-803B-B3AE1B07A49E?page=1) -- [Answer](x-devonthink-item://00427DF6-6D28-4FEB-A0CA-DF96DBBBCE97?page=21) - [x] DUPLICATE Q: [Collapse and Abnormal ECG](x-devonthink-item://3F154834-B3DA-4ADD-8596-C57D6EC9C8A8?page=1) -- [Answer](x-devonthink-item://CF07FAA1-C055-4A43-BFEE-A0DA2DD95452?page=1) - [ ] 75Q: [If Time is Money This Guy is Broke](x-devonthink-item://1EA9311E-0B9E-49F7-8D6E-4C4187A838C4?page=48) -- [Answer](x-devonthink-item://B1CB2E8F-5D04-49EE-8274-043871389D28?page=30) - [ ] [hyperkalaemic arrest](x-devonthink-item://5DD7C01C-AB9B-4F0E-9CC4-266700BD94E8?page=15) -- [Answer](x-devonthink-item://7CE81625-E4A6-40C1-BAEB-7E44C75B1E60?page=18)