Hyperkalemia in MRCP (2)

Hyperkalemia in MRCP (2)

OK, if you are currently working in any hospital around the world, you certainly agree with me that hyperkalemia always disturbs you a lot. I remember that when I was a house officer many years ago, I was once called by staff nurse because she was worried that patient may collapse simply because his Potassium level was 5.4!


I think the general principles of treating hyperkalemia are simple,

First,

You have to act fast to avoid cardiac arrhythmia.

Second,

To shift the Potassium back to the cell ( intracellular) from extracellular ( plasma) if possible.

Third,

To reduce total body Potassium

Fourth,

AND of course, find out the underlying cause of hyperkalemia.


I will not discuss how aggressive you want to treat hyperkalemia and I think it is a judgment call. Anyway, I would be certainly very worried if the Potassium level is more than 6.5 and there is ECG changes. ( Learn about hyperkalemia associated ECG changes, it is a popular question in MRCP).

So, treatment of hyperkalemia can be outlined as below,

I think the very first step to take is to stabilize the heart by giving Calcium gluconate or Calcium chloride. You may want to open your physiology book to learn the mechanism how Calcium acts.

Then ,of course, you want to try to shift back the Potassium back to the cell by giving insulin and glucose. In Malaysia, the combination of insulin, glucose and Calcium therapy in treating hyperkalemia is termed as cocktail regime!

You can also use beta agonist to shift the Potassium back to the cell. Another useful strategy is bicarbonate infusion. Remember, acidosis causes hyperkalemia, therefore alkalosis corrects hyperkaelmia.
Another strategy you may want to try is giving patient cation exchange resin. However, remember that the effect is not immediate, therefore, you have to use previous various strategies to bring down the Potassium level promptly.

Anyway, I must say the most powerful way of treating your hyperkalemia is haemodialysis!!