Hyperkalaemia K+ Potash

High K+: Broad PR, Broad QRS, no P, Tall Tented T-waves/asystole/sine/VT.  7!

Peaked T-waves, Long PR interval, then no P wave with BROAD QRS, VT/VF.

-10% 10ml Ca Gluconate every 10 mins up to fifty (cardioprotective – but lasts 30 mins);
– Lower plasma K+ with Insulin/Dex (10 units actrapid to 50ml 50% glucose over 30 mins) while checking BM’s before, during, after
– 10mg Neb Sab to drive K+ into cells where it belongs.

Calcium resonium + lactulose to remove K+. Or haemodialysis.

Treat in long-term by giving: Furosemide or Thiazide.

Don’t give AMILORIDE, SPIRO (K+ sparing diuretics). Don’t give ACEi, ARB’s, NSAID’s, HEPARIN. Beware: Ciclosporins, tacrolimus, pentamidine, co-trimoXazole.

Don’t give BETA-BLOCKERS OR DIGOXIN.
DKA can cause high K+, as can DIGOXIN TOXICITY or beta-blockade or too long a tourniquet.

“In patients with renal impairment, the ACE inhibitors and angiotensin-II receptor antagonists are very effective and reduce blood pressure and possible albumin loss but they must be used with care to prevent hyperkalaemia. “

Insulin pushes glucose AND potassium into cells, geddit?
Muscle weakness/flaccid paralysis, depressed or no tendon reflexes.

No P-waves, PEAKED TALL T-WAVES:

3-5ss (0.12 to 0.20). FIST THE PEE WAVE!

Short PR – WPW. Broad PR – block.
Broad QRS – BBB, hi K+, ventricular rhythm.

T-wave: 5mm in Roman limb leads, 10mm praecordial leads (V1-V6).  5mm roman, 10mm V.

Long QT – Sotatol, amiodarone, lo Ca, Eloise’s neck.

ST depression: PE, acute posterior MI, dig effect (and small T-waves).
ST elevation: LBBB, acute pericarditis

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