Core Module

Hyperkalaemia

Introduction

Hyperkalaemia is a frequent issue identified in hospitalised patients, affecting 1-10%. It is important to understand the causes, assessment and treatment as hyperkalaemia can lead to life-threatening cardiac arrhythmias, cardiac arrest and respiratory depression. Hyperkalaemia is a medical emergency. 

It is vital that the Junior Doctor has a good framework for approaching the various causes of hyperkalaemia, can determine severity and understands the different tiers of treatment depending on the severity of the hyperkalaemia.

Content Contributors:

Author: Dr Elisabeth O’Brien

CONTENT APPROVAL: Dr Christian Farrugia
EDITOR: Dr Sahani Jayawardane

Version History Version
Version 1 – July 2021

  • It requires 20 minute preparation.

  • It can be taught in 1 hour


Teaching approach

As with all modules, familiarise yourself with the NPMT principles.

session learning objectives:

  • Students must identify hyperkalaemia as a medical emergency and develop a framework for analysing the various causes 

  • To understand the assessment of hyperkalaemia including primary survey, history, exam and investigations 

  • To understand the treatment of hyperkalaemia based on the severity of the hyperkalaemia identified

Tips & Tricks on running an effective session:

  • Students should consider the large differences between intracellular (155mmol) and extracellular (3.5-5mmoll) Potassium to understand the importance of this electrolyte in cardiac and skeletal muscle function

  • It should be emphasised that if a patient is symptomatic or has signs of hyperkalaemia (eg ECG changes) this should be managed as severe hyperkalaemia and treated immediately. 

  • it should be emphasised to students that if potassium rises slowly, often signs and symptoms do not develop until levels are >7.0mmol/L. If the change is more acute, these signs and symptoms can develop rapidly.

  • Students should be prompted to develop a framework to break down the various causes of hyperkalaemia. Consider going around the room, asking each student to volunteer a cause. 

  • Students should be aware that some diuretics can cause hyperkalemia (spironolactone) and others are used to treat it! (frusemide). 

  • It should be emphasised to students that a patient’s serum potassium should not be the only indicator for management. Urgent treatment is indicated if Potassium level >7.0 OR >5.5 with ECG changes or symptoms.

  •  Students should have a go at using the fluid chart to show how they would chart fluid and dextrose solution for severe hyperkalaemia

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