Hyperkalemia 

ECG changes 

5.5 - 6 - tall tented t wave 

p wave - 6.5 - 7.5 

widened qrs - 7 - 8 mmol

sine wave 8 mmol

5.5 and above - calcium reconium

6 - lytic cocktail 

Hyperkalemia causes 

Pseudohyperkalemia - drip hand, lysed sample @@@@

drug causes - ace inhibitor / aldosterone antagonist ( eg spirolactone ) 

tumor lysis syndrome, rhabdomylysis 

reduced potassium excretions 

Approach to hyperkalemia 

• review med history : chd, diabetes, hypoaldosterism, addison disease

• review medications: ace, arb, spirolactone ( mineracorticoid antagonist _ 

• DKA - acidosis ? 

• 
  

• Increase hydration to approximately 4 L/m2/day. Drive urine output with frusemide (2 mg/kg, IV) as necessary, i.e., if output drops below 2-3 mL/kg/hr.

• Correct acidosis if present.

• Consider Resonium-A 15-30 g PO or PR q6h.

• Consider glucose/insulin (50 mL of 50% dextrose IV plus 12 units of actrapid insulin IV), or an infusion.

• Consider salbutamol nebulisers.

• Dialysis may be required

adrenaline concentration to stop bleeding 1: 1000

1ml soaked in gauze 

adrenaline concentration 1: 10,000 used in resuscitation 

HYpokalemia 

psuedohypokalemia 

prolonged clenchfisting, prolonged torniquet applied, taking sample from drip arm @@@ 

hypokalemia < 2.5, ECG changes : flattened T wave, prolonged qt, st depression

Hypokalemia in diabetic patient 

DKA - taking insulin infusion - insulin can cause potassium to move into cells 

malnourished patient receiving sugar treatment - low potassium, low magnesium, low phospahte 

Medications such as salbutamol, epinephrine, pseudoepinephrine - hypokalemia

hypokalemia - hyperthyroid - TPP thyroid periodic paralysis - 

propanalol 3mg 

Other extra-renal causes of hypokalemia 

Ogilvie syndrome ( pseudoobstruction ) after surgery - Caesarean section, abdominal surgery - functional dilatation of colon instead of mechanical cause 

nausea and vomiting 

longterm diuretic use can cause secondary   hyperalderstornism - low potassium ( aldosterone causes sodium retention and potassium excretion ) 

chronic laxative use 

diuretics such as thiazide and furosemide ( loop diuretics ) - low potassium 

low magnesium ---> low K+ 

 Distal tubule sensitive aldosterone - SAME syndrome 

Syndrome of Apparent Mineralocorticoid Excess 

Enac channel 

- regulation and sodium and potassium balance - reabsorb sodium and excrete potassium 

- liddle syndrome : increased Enac channel activity : hypertension, low potassium

high glucocorticoid ( cortisol ) - can also causes low potassium - 

Adrenocorticotropic hormone high - cushing syndrome 

TALH dysfunction : thick ascending loop of henle dysfunction 

can affect electrolyte regulation 

barter syndrome - low potassium with high urine calcium level 

Distal collecting tubule dysfunction - 

Gitelman syndrome : mutation in SLC12A3 gene, affect tlhiazide senstive NaCL cotransporter 

low magnesium,lowpotassium    with low urine calcium