Академический Документы
Профессиональный Документы
Культура Документы
and Hypokalaemia
Potassium homeostasis
Obtained through the diet -GI absorption is complete - daily excess intake of
about 1 mEq/kg/d (60-100 mEq) - is excreted through the kidneys (90%)
and the gut (10%).
low K diet
Cation exchange-resins
Correction of acidosis in patient with metabolic acisosis
+/- Glucose & insulin infusion
stop drugs which may cause hyperkalaemia
K-sparing diuretics, spironolactone, triamterene, amiloride
NSAIDS
ACE-I
ARB
Cyclosporine or tacrolimus
Pentamidine
Trimethoprim/sulfamethoxazole
Heparin
Ketoconazole
Metyrapone
Herbs
Severe Hyperkalaemia (>6.5 mmol/L) or
with ECG changes
Above treatments
Immediate Calcium administration
Glucose and insulin infusion
Sodium bicarbonate infusion
Beta agonist therapy
Dialysis
Calcium administration
10ml of 10% calcium gluconate IV over 2-5
minutes. A 2nd dose can be given after 5 mins if
no change in ECG is seen. Effect of calcium
occurs within minutes and lasts for 1 hour
Slower infusion rates in patients on digitalis to
avoid hypercalcaemia-induced digitalis toxicity
Calcium should not be given before after
bicarbonate in the same IV line to avoid
precipitation
Glucose and Insulin infusion
Rapid acting insulin 10u + 50cc of 50% dextrose
IV infused over 30-60min (in pt with renal failure,
higher dose of glucose needs to be given, e.g.
100-150 ml of dextrose)
Onset within 30-60 min & lasts for several hours
The above regime can be repeated 6-8 hourly
Bolus hypertonic glucose solution may
transiently exacerbate hyperK by its osmotic
effect on cells
After insulin & dextrose infusion, maintain pt. on
continuous dextrose infusion, e.g.D5%
Sodium bicarbonate infusion
IV infusion of bicarbonate 100-200 mmol/l
over 30 min produces metabolic alkalosis
which lowers K in ECF
Onset of action occurs within 30 min &
lasts for 1-2 hours
It is less effective in patients with renal
failure
Cation-exchange resins (Resonium A)
Beta-agonist therapy
IV salbutamol 0.5 mg in 15 min or 10 mg neb
( with or without glucose & insulin infusion) has
been shown to be effective in reducing K level
(IV is preferred in pt with ESRD)
If effective, plasma K will fall by 0.5-1.5 mmol/l in
15-30 min & effect will last for several hours
Pathophysiology -Hypokalaemia
Poor K intake - seen in very elderly individuals unable to cook for
themselves or unable to chew or swallow well or in pt.s receiving TPN,
where K supplementation may be inadequate for a prolonged period of time.