The ECG (Figure 2 shown on page 15) is of a haemodialysis patient presenting with pulmonary oedema.
c) What test will you do to confirm the likely underlying diagnosis? (10% marks)
d) What is your immediate management for this condition? (20% marks)
c) Potassium level
d) Counteract cardiotoxic effects of hyperkalaemia
• Calcium chloride
• Sodium bicarbonate
Shift potassium into the cells
• Dextrose and insulin
• Beta agonists
Remove potassium (and water)
• Urgent haemodialysis
Classical ECG features of hyperkalemia:
Montague (2008) found that these were generally unreliable. The ECG used here is not from the college paper, but rather represents the ECG of an end stage renal failure patient presenting with syncope. The serum potassium level was 7.9.
Management of hyperkalemia is discussed elsewhere. In brief, it consists of the following strategies:
Stabilize myocardial cell membrane:
Shift potassium into cells:
Promote potassium excretion:
Lavonas, Eric J., et al. "Part 10: Special Circumstances of Resuscitation 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Circulation 132.18 suppl 2 (2015): S501-S518.
Weisberg, Lawrence S. "Management of severe hyperkalemia." Critical care medicine 36.12 (2008): 3246-3251.
Montague, Brian T., Jason R. Ouellette, and Gregory K. Buller. "Retrospective review of the frequency of ECG changes in hyperkalemia." Clinical Journal of the American Society of Nephrology 3.2 (2008): 324-330.