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⚡ Hyperkalaemia

A Life-Threatening Electrolyte Emergency

Clinical Guide for Medical Students

📋 Definition

Hyperkalaemia is defined as:

Serum K⁺ > 5.0 mmol/L

🔍 Causes of Hyperkalaemia

1️⃣ Increased Intake

• • Dietary potassium (excessive consumption)
• • Potassium-containing intravenous fluids

2️⃣ Redistribution from Cells

• Acidosis (metabolic)
• Insulin deficiency
• Severe hyperglycaemia
• β-blockers
• Hyperkalaemic periodic paralysis
• Severe haemolysis
• Tumour lysis syndrome

3️⃣ Reduced Urinary Excretion

• Acute kidney injury (AKI)
• Chronic kidney disease (CKD)
• Addison's disease (adrenal insufficiency)

⚠️ Clinical Features

🚨 Key Clinical Points

• ✓ Progressive muscular weakness (more severe cases)
• ✓ Often asymptomatic until critical levels
• ⚡ May present with sudden cardiac arrest

⚠️ The Silent Killer: Hyperkalaemia can be fatal without warning symptoms!

Treatment of Severe Hyperkalaemia

Indicated when K⁺ typically > 6.5 mmol/L

1

Stabilise Cell Membrane Potential

IV Calcium Gluconate

10 mL of 10% solution

💡 Works within minutes to protect the heart

2

Shift K⁺ into Cells

• Inhaled β₂-adrenoceptor agonist (e.g., salbutamol)
• IV Glucose + Insulin
  50 mL of 50% glucose + 5–10 IU rapid-acting insulin
• IV Sodium Bicarbonate

💡 Onset: 15-30 minutes

3

Remove K⁺ from Body

• IV Furosemide + Normal Saline
  Enhances renal excretion
• Ion-exchange Resin
  Orally or rectally (e.g., calcium resonium)
• Dialysis
  For refractory cases or renal failure

💡 Definitive treatment - actually removes potassium

📊 Treatment Algorithm

SEVERE HYPERKALAEMIA
K⁺ > 6.5 mmol/L

STEP 1: IV Calcium Gluconate
(Cardiac protection)

STEP 2: Shift K⁺ into Cells
(Insulin+Glucose, β₂-agonist, Bicarbonate)

STEP 3: Remove K⁺ from Body
(Diuretics, Resins, Dialysis)

🎯 Key Clinical Pearls

• ✅ Calcium first - protects the heart immediately
• ✅ ECG monitoring - essential in all cases
• ✅ Treat the cause - not just the potassium
• ✅ Repeat K⁺ levels - monitor response to treatment
• ✅ Dialysis - definitive for renal failure

📈 ECG Changes in Hyperkalaemia

Early: Tall, peaked T waves

Moderate: Prolonged PR interval, flattened P waves

Severe: Wide QRS, sine wave pattern

Terminal: Ventricular fibrillation/asystole

#Hyperkalaemia #ElectrolyteEmergency #MedicalEducation

#ClinicalPharmacology #PatientSafety #InternalMedicine

"Time is muscle - rapid recognition and treatment saves lives!" 💙

Disclaimer: For educational purposes. Always follow local protocols and consult seniors.

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