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What are the 4 biggest risk factors for hyperkalemia in heart failure patients?
Poor creatinine clearance
The causes of hyperkalemia can be classified into which 4 groups?
Potassium redistribution - extracellular shift
What is the most common cause of hyperkalemia?
Which type of renal tubular acidosis causes hyperkalemia?
How do you classify the causes of potassium extracellular shift resulting in hyperkalemia?
e.g. hyperglycaemia, volume depletion leading to hypertonicity
e.g. tumour lysis syndrome, rhabdomyolysis, haemolysis
e.g. propofol infusion syndrome, suxamethonium, digitalis intoxication syndrome
What are 4 common exogenous sources of potassium?
Total parenteral nutrition
Packed red blood cell transfusion
What are the symptoms of hyperkalemia?
What are the signs of hyperkalemia?
Decreased bowel sounds
What are the ECG changes that accompany hyperkalemia - divided into early, intermediate and late changes?
tented T waves (most common), shortened QT interval
widened QRS complex, flattening and loss of p wave, increased PR interval progressing to complete heart block
sinusoidal pattern, ventricular fibrillation
Do most patients with hyperkalemia have an abnormal ECG?
No - from a 1998 cohort study of 242 patients, 46% had ECG changes
How do you manage hyperkalemia?
Protect the heart:
IV calcium glucanate
Shift potassium into cells:
insulin + dextrose, sodium bicarbonate, beta agonists e.g. salbutamol
Get potassium out of the body:
resonium, frusemide, dialysis
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