- Definition (as from ALS 2 Manual): >5.5 mmol/L
- Severe hyperkalaemia: >6.5 mmol/L
Aetiologies
- Renal failure
- Drugs (ACE-i, ARB, potassium sparing diuretics, NSAIDs, ß-blockers, trimethoprim)
- Tissue breakdown (e.g. rhabdomyolysis, tumour lysis, haemolysis, burns)
- Metabolic acidosis (e.g. renal failure, diabetic ketoacidosis)
- Endocrine disorders (e.g Addison disease)
- Pseudo-hyperkalaemia secondary to prolonged transit time or poor storage conditions
Clinical Features
- Muscle - weakness (legs > arms)
- Cardiac conduction abnormalities
Workup
- Exclude pseudohypohyperkalaemia
- Evaluate renal function and medication list
- Evaluate for hypoaldosternism by checking renin, aldosterone and cortisol
Management
- Fluid resuscitation in order to enhance renal perfusion and elimination
- Membrane stabilisation with calcium
- 10mL of calcium gluconate or chloride over 2-5 minutes
- Shift potassium into cells
- Bicarbonate infusion 50-100mL of 8.4% (1 mmol/kg) IV over 5 minutes
- Requires a metabolic acidosis to be present
- Do not administer at same time as calcium as it can cause precipitation
- Insulin/dextrose infusion
- 10U actrapid + 50mL of 50% glucose
- Reduces potassium by 0.65-1 mmol/L/hr
- Salbutamol nebulisers or IV
- 0.5 mg IV or 20 mg (2-4 nebs) nebulised
- Increase potassium excretion
- Diuretics
- Mannitol and frusemide theoretically work but are not routinely used in hyperkalaemia management
- Dialysis
- Resonium
- Rare side effect of intestinal necrosis in patients with bowel obstruction, ileus or opioid use
Hyperkalaemic Cardiac Arrest
- Don’t stop until potassium normalised
- adrenaline helps drive potassium down
- Calcium chloride
- Sodium bicarbonate in acidosis
- At ROSC start insulin/dextrose
Source