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Electrolyte Abnormalities
 
Electrolyte Abnormalities
 

Hyperkalaemia

 
 
 
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Overview

Hyperkalaemia, or an increased serum potassium concentration of >5mmol/L, shortens action potentials and reduces conduction velocity in cardiac myocytes.

Pathogenesis

  • Causes of Hyperkalaemia

  • Factitious

  • Haemolysis (e.g. poor collection, delay in lab processing)
  • Leukocytosis / thrombocytosis
  • Increased Intake / Production

  • Exogenous administration - massive transfusion, potassium supplements, TPN
  • Endogenous production - rhabdomyolysis
  • Reduced Excretion

  • Renal failure - acute or chronic
  • Medications - NSAIDs, ACE inhibitors, ARBs, spironolactone, trimethoprim
  • Addison’s
  • Compartmental Shift

  • Type 4 renal tubular acidosis
  • Metabolic acidosis
  • Hyperglycaemia
  • Beta blockers
  • Trauma / burns

Manifestations

  • Clinical Features

  • Paraesthesia
  • Flaccid paralysis
  • Hypotension
  • Bradycardia
  • Arrhythmia
  • ECG Findings

  • Mild

  • Tall, tented T waves
  • Moderate

  • Reduction in P wave height
  • Long PR interval
  • Severe

  • Short QT interval
  • Widening of QRS complex
  • Sine wave QRS pattern
  • Life-Threatening

  • Asystole
  • Manifestations
     

Diagnosis

  • Severity of Hyperkalaemia

  • Mild - 5.0 - 6.5 mmol/L
  • Moderate - 6.5 - 7.0 mmol/L
  • Severe - >7.0 mmol/L
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