Electrolytes

Question 1

Name the most common drug causes of hyperkalaemia

Answer 1

K+ sparing diuretics (spironolactone, epleronone)
ACEi (ramipril)
AngIIB (candesartan)
NSAIDs also add to this effect by reducing RAAS

Question 2

1st step in managing hyperkalaemia?

Answer 2

Calcium gluconate 10% 10ml IV over 2 mins
(slower rate if on digoxin)
To stabilise cardiac membrane before lowering K+

Question 3

When treating hyperkalaemia, what is done after stabilising cardiac membrane?

Answer 3

IV insulin (5–10 units) with 50 mL glucose 50% given over 5-15 minutes, repeated or a continuous infusion. 
Salbutamol by nebulisation or slow intravenous injection 
Correction of causal or compounding acidosis with sodium bicarbonate infusion  Drugs exacerbating hyperkalaemia should be reviewed and stopped as appropriate; occasionally haemodialysis is needed.