Hyperkalemia ☺️

Question 1

Causes

Answer 1

AKI
Drugs - K sparing diuretics, ACEi, ARB, Bb, ciclosporin, heparin
Metabolic acidosis
Addisons
Rhabdomyolysis
Massive blood transfusion

Pseudohyperkalemia if blood samples aren’t processed in time

Question 2

What are the clinical manifestations of hyperkalemia

• early
• late

How would this be detected?

Answer 2

Muscle weakness
Urine ouput little/none => AKI
Resp failure => from muscle weakness
Decreased cardiac contractility => weak pulse, low HR
Early muscle twitches
Rhythm changes

Question 3

ECG changes

Answer 3

Tented T
No P
Broad QRS
Sinusoidal => asystole

Question 4

Presentation, investigations, management for Addisons

Answer 4

Postural hypotension, salt wasting
-dehydration, prone to AKIs
-high urea
Low Na, high K
Hyperpigmentation 

Random cortisol
Synacthen test
-if primary => ACTH high prior to test
=> after test, cortisol <550

Hydrocortisone, fludrocortisone => MC, GC

Question 5

Initial management

Further management

Answer 5

IV Ca gluconate - stabilise cardiac

Insulin dextrose infusion
-can use neb salbutamol

Remove K
-Ca resonium/loop/dialysis

Stop exacerbating drugs
Treat underlying cause