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Hyperkalaemia (serum potassium >5) (Anaesthetic management (Treatment…
Hyperkalaemia (serum potassium >5)
Causes
Increased intake
IV fluids
K supplements
Massive transfusion
Decreased loss
Renal: volume depletion, RF, Spironolactone, NSAIDs, ACEi
Endocrine: Addison's
Shift from ICF to ECF
Acidosis
Suxamethonium (extrajunctional ACh receptors in the following)
Muscular dystrophy
Unhealed 3rd degree burns
Denervation
Severe skeletal muscle trauma
UMN lesions
Avoid after 1-2 days for 1-2 years
Rhabdomyolysis
Anaesthetic concerns
Clinical features depend on acuity
Paralysis issues
Arrhythmias
Anaesthetic management
Confirm diagnosis
Exclude pseudohyperkalaemia from haemolysed sample
Serum K should be <5.5 for elective surgery
Treatment (urgent if arrhythmia or ECG changes)
Cardiac stabilisation if >6.5 or wide QRS Cal Gluc 10% 10ml over 2 min)
Move K to ICF
Insulin 10 units and Glucose 50ml 50% over 5 mins). Will reduce by 1 mmol/l in30 mins)
Sodium Bicarb 8.4% 50ml over 5 mins (if met acidosis)
Hyperventilation
+/- nebulized Salbutamol 10mg
Eliminate K form body
Correct volume depletion with N Saline
Frusemide
Dialysis if severe or in pts with poor renal fx
Resonium resin 15g PO or 30g PR if less urgent (will reduce by 1mmol/l in >1 hr
Avoidance of further increased K
Avoid Sux
Avoid acidosis
Avoid K containing IVF
Muscle relaxation
Increased effects of depolarizing NMBs and reduces effects of NDMBs