Hyperkalaemia - Management of Acute Hyperkalaemia in Adults



Canberra Hospital and Health Services

Clinical Procedure

Hyperkalaemia – Management of Acute Hyperkalaemia in Adults

|Contents |

Contents 1

Purpose 2

Diagnostic Parameters 2

Alerts 2

Scope 2

Section 1 – Management 3

Section 2 – Treatment 3

Section 3 – Medications that may cause hyperkalaemia 4

Implementation 4

Related Policies, Procedures, Guidelines and Legislation 4

Definition of Terms 5

Search Terms 5

Attachments 5

Attachment 1: Flow Chart: Hyperkalaemia in Adults - Decision Making Tool 6

|Purpose |

The purpose of this procedure is to guide management of patients with hyperkalaemia

|Diagnostic Parameters |

Mild hyperkalaemia:

• Serum potassium concentration 5.0-6.0 mmol/L

• Nil or Peaked T wave

Moderate hyperkalaemia:

• Serum potassium concentration 6.1-7.0 mmol/L

• Peaked T Wave, shortened QT interval

Severe hyperkalaemia:

• Serum potassium concentration > 7.0 mmol/L

• Widening of QRS interval.

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|Alerts |

1. In severe acute renal failure, dialysis should be the first option considered

2. The flow chart attached is a decision making tool. All steps should occur almost simultaneously unless otherwise stated.

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|Scope |

This document applies to staff who are working within their scope of practice:

• Medical Officers

• Registered Nurses and Registered Midwives

• Students under direct supervision.

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|Section 1 – Management |

1. Hyperkalaemia identified

2. Exclude pseudohyperkalaemia

3. Treat underlying conditions:

1. Dehydration: treat with fluids. Isotonic bicarbonate (seek advice) if acidotic pH6.0mmol/L)

1. Treat with glucose 50% 50mL over 15 minutes together with regular insulin (e.g. Actrapid) 10 units intravenously. As an alternative/in addition to the above use salbutamol 10 mg by nebuliser

2. Sodium polystyrene sulfonate (Resonium A) 30g orally OR in 100mL of sorbitol/water as retention enema for one hour

3. Are there ECG changes? Treat with calcium gluconate 10% 10mL (2.2 mmol) intravenously over 3 minutes (with ECG monitoring of response).

Note: The effect of IV calcium gluconate is short-lived and dose may need to be repeated in 30 to 60 minutes.

• If initial potassium was >7.0 mmol/L recheck in 1 hour

• If initial potassium was between 6.0-7.0 mmol/L recheck in 2 hours

• If remains high, further IV insulin and dextrose

• Consider referral for opinion ± dialysis.

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|Section 3 – Medications that may cause hyperkalaemia |

• Potassium supplements (IV or oral)

• Potassium-sparing diuretics (e.g. amiloride, triamterene, spironolactone)

• ACE-inhibitors (e.g. captopril, enalapril)

• Angiotensin receptor blockers (e.g. irbesartan, candesartan)

• Acute digoxin toxicity

• Aldosterone antagonists (e.g. spironolactone, eplerenone)

• Nonsteroidal anti-inflammatory agents

• Cyclosporin

• Tacrolimus

• Trimethoprim

• Pentamidine.

Notes

1. In severe acute renal failure, dialysis should be the first option considered

2. The flow chart (Attachment 1) is a decision making tool. All steps should occur almost simultaneously unless otherwise stated.

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|Implementation |

This document will be available on the CHHS Policy Register (via Sharepoint). It will be discussed in existing program of education (orientation, in-service). Emailed to staff and placed in workrooms.

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|Related Policies, Procedures, Guidelines and Legislation |

Policies

• CHHS Consent and Treatment

• CHHS Medication handling Policy

• CHHS Patient Identification and Procedure Matching Policy

Procedures

• CHHS Pathology requests and specimens Procedure

• CHHS Patient Identification and Procedure Matching Procedure

Legislation

• Medicines, Poisons and Therapeutic Goods Act 2008

• Medicines, Poisons and Therapeutic Goods Regulation 2008

• Therapeutic Goods Act 1989

• Therapeutic Goods Regulations 1990

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|Definition of Terms |

Pseudohyperkalemia: a rise in serum potassium concentration with concurrently normal plasma potassium concentration

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|Search Terms |

Hyperkalaemia, Mild hyperkalaemia, Moderate hyperkalaemia, Severe hyperkalaemia, Acute Hyperkalaemia, potassium k, K+, high

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|Attachments |

Attachment 1: Flow Chart: Hyperkalaemia in Adults - Decision Making Tool

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:

|Date Amended |Section Amended |Divisional Approval |Final Approval |

|Minor review and extension |Whole document |Girish Talaulikar, ED, Medicine |Chair, CHHS Policy Committee |

| | | | |

This document supersedes the following:

|Document Number |Document Name |

| | |

| | |

Attachment 1: Flow Chart: Hyperkalaemia in Adults - Decision Making Tool

[pic]

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Hyperkalaemia Identified

Confirm potassium level with a second test, but treat immediately.

Treat underlying conditions:

* Dehydration: treat with fluids. Isotonic bicarbonate if acidotic pH6 mmol?L

Mild Hyperkalaemia 5-6 mmol/L

Stop offending drugs

Review after 24 hours

Treat with insulin and dextrose and/or nebulised sulbutamol

Resonium A orally and rectally. Oral takes 6 hours for effect

ECG changes? Treat with IV calcium gluconate

Resonium treatment if no resolution

Referral rather than long term Resonium

Potassium >7 recheck in 1 hour

Potassium 6-7 recheck in 2 hours

If remains high, further IV insulin and dextrose

Consider referral for opinion ± dialysis

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