Tag Archives: bloods

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

Bloods, hyperkalaemia, hypokalaemia.

Normal MCV: Acute loss, ACD.
Low MCV: Iron-def, Thalaessaemia. (Mennorhagia)
High MCV: B12/Folate def.

Neutrophilia = Infection. Infarct. Inflammation. Cancer. Myeloproliferative. Preggers/exercise.
NEUTROPAENIA: Infection/Drugs/Autoimmune/EtOH.

Eosinophilia – Steroids. Asthma etc.
Lymphophilia: CLL/Lymphoma/NO SPLEEN/renal failure–> raised lymphocytes.

Raised platelets:
a) Reactive i.e. cancer, chronic inflammation, no spleen (raised lympho’s and platelets), haemolysis (raised platelets)
b) Cancer: PCV. Myelfibrosis. ET.

Low platelets:
– Infilitration of marrow e.g. by lymphoma, myelofibrosis.
– Nutrients: Low B12/folate –> macrocytic anaemia and low platelets.
– Destruction: DIC/ITP/Infections
– Too much of a spleen – Lymphoma or liver disease causing hypersplenism.

Too much spleen –> low platelets. Too little spleen –> High platelets. Paradoxical buggers, platelets.

BIG K+:
– Acidosis releases potassium.
– Renal failure causes high potassium.
– Addisons (adrenocortical deficiency) causes high potassium.
– Digoxin and amiloride cause high potassium.

Big K+: No P wave, prolonged PR interval, broad QRS, peaked T waves. Eventually hyperkalaemia causes sinusoidal. 
Hyperkalaemia = Ca gluconate, Insulin-Dex, Neb Sab, Dialysis

Low K+: Renal or GI loss.
1) Renal loss – RTA, Conn’s (lots of aldosterone).
2) GI loss via D + V (Eloise had LOW POTASSIUM and she is also an asthmatic – sab!)
3) Insulin causes low potassium. Acidosis causes high potassium.
4) Salbutamol

Low Na: Replace no more than 10mMol in a day
High Na: Due to water loss e.g. too many drips, Inspidus, Conn’s (aldosterone!)

Addison’s is reduced adrenocortical drive. Low Na, high K+, high Ca++.
Cushing’s is excess of glucocorticoids (cortisol up). OPPOSITE of ADDISON’S.
Conn’s is excess of aldosterone. Low K+ with normal or high sodium.

Raised urea, normal creatinine = dehydration, GI bleed, high protein diet.
Urea + creatinine up = Renal failure.

CRF –> Causes anaemia of chronic disease, lowered Calcium in chronic renal failure, high phosphate.

Low Sodium – Hyponatraemia

Hypervolaemia: Nephrotic & CCF & EF & Liver failure.

Euvolaemia + hi urine osmol = SIADH.
Euvolaemia + lo urine osmol = SubTHN; Glucocorticoid lack; H2O Overload.

Hypovolaemia + low urine Na under 20 => GI/Burns/Pancreatitis i.e. Vom; Diarr; Burns; Pancreatis; SBO.

Hypovolaemia + high urine Na over 20 => RENAL LOSSES i.e. kidney loses sodium into urine.
Renal losses i.e. Addison’s; ARF/ATN; DIURETICS.

Let’s approach it another way: Diuretics cause – low Na, low volume status, but HIGH urinary  sodium. Okay…