SAQ 301 – Metabolic – hyperkalaemia ECG and treatment
Model Answer
Metabolic – hyperkalaemia ECG and treatment.
a. Diagnosis
- Severe hyperkalaemia.
b. ECG features
- Broad QRS complexes, including QRS >160 ms.
- Tall peaked T waves.
- Absent or flattened P waves.
- Extreme axis.
- Prolonged QT or sine-wave tendency.
c. Immediate medications
| Medication | Dose and route | Purpose |
|---|---|---|
| Calcium gluconate 10% | 10 mL IV, titrated to ECG effect | Membrane stabilisation; calcium is essential. |
| Calcium chloride 10% | 10 mL IV via secure access | Alternative calcium salt for membrane stabilisation. |
| Short-acting insulin plus dextrose | 5-10 units Actrapid/Novorapid IV or SC with 25-50 mL of 50% dextrose | Shift potassium intracellularly. |
| Salbutamol | 5-20 mg nebulised, 6-12 puffs MDI, or 500 mcg IV over 20 min | Shift potassium intracellularly. |
| Sodium bicarbonate 8.4% | 50-100 mL IV | Adjunct if acidotic. |
| Furosemide | 20-40 mg IV | Potassium elimination if passing urine. |
| Sodium polystyrene sulfonate | 15 g orally | Potassium removal; not immediate rescue therapy. |
d. Reducing non-adherence
- Provide written instructions and an up-to-date medication list.
- Use blister packs, pillboxes, and clear labels.
- Involve the pharmacist for education or medication review.
- Communicate medication changes to the community pharmacy and GP.
- Engage family, carers, or community supports.
- Use phone reminders or other reminder systems.
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