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Death by Bananas

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Hyperkalemia results in: Inhibition of atrial myocardial depolarization. Slowing of heart rate. Prolonging QRS duration; complexes may become bizarre. – PowerPoint PPT presentation

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Title: Death by Bananas

1
Death by Bananas

The Management of Hyperkalaemia
Dr. Kiaran Flanagan, Clinical Lead Acute Medicine
UHCW
June 2012

2
Case 1

Patient comes into ED referred by GP for high
potassium of 6.7
You see the notes in the SIFT tray
What do you do? ...

3
How to manage

Pick up notes and PUT STICKER ON THE LIST
ABCDE
What are you likely to find?
What urgent investigation do you need to make a
treatment decision?
What action would you take if
1. Normal
2. Abnormal

4
What next?

History...
Examination...
Further tests
What are you looking for?

5
What next...

Senior review?
Actions you should recommend...
Drugs
Monitoring
Admit/ Discharge
Further checks
Anticipated future actions
How will you make this happen?

6
Case 2

Patient on the ward
ATSP unwell, vomiting
Day 2 of admission post op R hemicolectomy
What do you do?

7
What do you do?

ABCDE
Investigations?
Monitoring...

8
Patient hyperkalaemic

What else do you look for?
What test needs to have been done?
What treatment do you need to give?

9
Recheck K at 3 hours

Still high...
What next?
Treatment
Advice
Monitoring

10
Recheck K at 6 hours

Still high...
What do you do?
Treatment
Monitoring
Ask for help
Who
What will you tell them and how?
What for

11
Case 3

Patient Medical ALERT to Resus
Drowsy
High glucose
What do you do????

12
What do you do?

ABCDE
Urgent tests
What is the diagnosis?
How do you manage?

13
Case 4

Cardiac Arrest Call
PEA
What do you think about?

14
Hyperkalaemia in cardiac arrest

What do you give?

15
Case 5

Called to ward 1, pt unwell
Low BP, low glucose, high potassium
What do you do?
Assessment
Further tests?
Working diagnosis
Treatment?

16
Causes of Hyperkalaemia

Decreased or impaired potassium excretion renal
failure, potassium-sparing diuretics, urinary
obstruction, sickle cell disease, Addison
disease, and systemic lupus erythematosus (SLE)
Additions of potassium into extracellular space -
potassium supplements (eg, PO/IV potassium, salt
substitutes), rhabdomyolysis, and hemolysis (eg,
blood transfusions, burns, tumor lysis)
Transmembrane shifts (ie, shifting potassium from
the intracellular to extracellular space) -
acidosis and medication effects (eg, acute
digitalis toxicity, beta-blockers,
succinylcholine)
Factitious or pseudohyperkalemia - improper blood
collection (eg, ischemic blood draw from
venipuncture technique), laboratory error,
leukocytosis, and thrombocytosis

17
Causes

Ineffective elimination
Kidneys
Drugs
Endocrine
Excessive release from cells
Injury
Metabolic
Excessive intake
Lethal Injection
Pseudo

18
ECG Changes
19
How does it affect the heart?

Hyperkalemia results in
Inhibition of atrial myocardial depolarization.
Slowing of heart rate.
Prolonging QRS duration complexes may become
bizarre.
Also known as atrial standstill.
Rhythm called sinoventricular rhythm.
The ECG is a poor substitute for serum potassium
levels to determine the degree of abnormality

20
ECG Changes

From reduction of P wave amplitude and
prolongation of PR interval to absence of P waves
altogether.
Increase of QRS duration.
Increase of QT duration.
Slowing of heart rate.
T waves become tall and spiked.
Decreased R wave amplitude

21
ECG Changes
22
3 Principles of Treatment