NAME:
Assess Patient Protect the Heart + Shift K into cells + Remove K from body +Monitor K and Blood Glucose Prevention
Emergency Management of
Hyperkalaemia in Adults
Hyperkalaemia (K+ ≥ 5.5 mmol/L) Consider initiating treatment if Hyperkalaemia suspected and K+ unknown ADDRESS: D.O.B.: CHI: Date: ___/___/___ Time: ___:___ Airway Breathing Circulation Disability Exposure (ABCDE) Approach Seek expert help if airway, breathing or circulation compromised First 15-30 min Na+: ______ K+: ____.__ 02 Sat: _____% RR: ______ BP: ____/___ Pulse: ______ EWS: ______ Perform 12-lead ECG MILD +K 5.5 - 5.9 mmol/L Consider cause and if treatment indicated MODERATE +mmol/L K 6.0 - 6.4 Treatment guided by clinical scenario, ECG and rate of rise SEVERE + K ≥ 6.5 mmol/L Emergency treatment indicated Urea: ____.__ Creat: ______ Time: ___:___ Seek expert help! Sick patient; K+ ≥ 6.5 mmol/L; Acute ECG changes present Monitor ECG in high dependency area Check K+ Send lithium-heparin sample to lab Use blood gas analyser if available Exclude pseudo-hyperkalaemia Dialysis patient: Contact Renal Unit Cardiac monitoring: YES/ NO Call for senior help: YES/ NO Renal or ICU referral: YES/ NO NO □ Peaked T waves □ Absent or flattened P waves □ Broad QRS □ Sine wave □ Bradycardia □ VT YES Acute ECG changes present (tick if present)? IV Calcium (6.8 mmol) 10 ml 10% Calcium Chloride IV OR 30 ml 10% Calcium Gluconate IV Use large vein Give over 5-10 min Calcium Chloride OR Calcium Gluconate IV Repeat ECG and consider further dose after 5 min if ECG changes persists Insulin–Glucose IV Infusion Give in severe hyperkalaemia Consider in moderate hyperkalaemia (assess ECG and rate of rise) Next 30-60 min Glucose (25 g) over 15 min 50 ml 50% Glucose OR 125 ml 20% Glucose, WITH Soluble Insulin – 10 units Salbutamol Give 10 mg if history of IHD Avoid if tachyarrhythmia present Blood Monitoring: Baseline Glucose __.__ K+ ___.__ 15 min Glucose __.__ 30 min Glucose __.__ 60 min Glucose __.__ K+ ___.__ Salbutamol 10-20 mg Nebulised Give in severe hyperkalaemia Consider in moderate hyperkalaemia (assess ECG and rate of rise) Consider Calcium Resonium 15 g x4/day oral or 30 g x2/day PR Consider Dialysis Seek advice from Renal or ICU team; patient transfer may be required K ≥ 6.5 mmol/L despite medical therapy Monitor serum K+ and blood glucose After 1st hour Blood Monitoring: 90 min Glucose __.__ 120 min Glucose __.__ K+ ___.__ 180 min Glucose __.__ 240 min Glucose __.__ K+ ___.__ 360 min Glucose __.__ K+ ___.__ 24 hours K+ ___.__ Consider cause of hyperkalaemia, prevent further rise and recurrence Stop all nephrotoxic medication including ace-inhibitors, angiotensin II receptor blockers, potassium-sparing diuretics, NSAIDS and assess diet K+: potassium; Na+: sodium; Creat: creatinine; IV: intravenous; min: minutes; PR: per rectum; EWS: early warning score; IHD: Ischaemic Heart Disease; NSAIDS: non-steroidal anti-inflammatory drugs Publication date: 1.03.14 Review date: 1.03.16
