Management of hyperkalaemia

Abstract

Hyperkalaemia, an elevated extracellular fluid potassium concentration, is a common electrolyte disorder and is present in 1-10% of hospitalised patients. Elevated serum potassium concentrations are usually asymptomatic but may be associated with electrocardiogram (ECG) changes. Hyperkalaemia occasionally leads to life-threatening cardiac arrhythmias. Prompt recognition of this disorder, patient risk management and administration of appropriate treatment can prevent serious cardiac complications of hyperkalaemia. Further assessment of the underlying basis for hyperkalaemia usually reveals a problem with renal potassium excretion (rather than transcellular shift of potassium or excess potassium intake). Reduced potassium excretion is typically associated with decreased potassium secretion in the aldosterone-sensitive distal nephron of the kidney. Common causes for hyperkalaemia include kidney failure, limited delivery of sodium and water to the distal nephron and drugs that inhibit the renin-angiotensin-aldosterone system. Treatment of life-threatening hyperkalaemia (particularly those patients with ECG changes) involves administration of intravenous calcium salts to stabilise the resting cardiac membrane potential. The potassium concentration can be lowered by administration of intravenous insulin combined with an infusion of glucose to stimulate intracellular uptake of potassium. Nebulised β-2 adrenoceptor agonists can augment the effects of intravenous insulin and glucose pending more definitive management of the recurrent hyperkalaemia risk. Additional management steps include stopping further potassium intake and careful review of prescribed drugs that may be adversely affecting potassium homeostasis. Changes to prescribing systems and an agreed institutional protocol for management of hyperkalaemia can improve patient safety for this frequently encountered electrolyte disorder.

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial

“…Importantly, what constitutes a Bhome hospital^is highly variable both nationally and internationally. 26,27 Our model involves a physician in the home, delivers twice-daily nurse visits and 24-h physician coverage, provides acute care similar to that received in a traditional hospital to acutely ill patients who otherwise would have been admitted, and offers cutting edge connectivity (continuous monitoring, video, and texting). This differs from most home-based models in its ability to handle high patient acuity and enmesh physician medical decision-making with a patient-tailored care team.…”

What are the key contextual factors when preparing for successful implementation of assistive living technology in primary elderly care? A case study from Norway

“…Older persons are substantial consumers of both hospital care and primary care services, 8 9 and a continuous discussion questions if a proportion of hospital admissions could have been prevented in primary treatment and care. 10 11 Previous research stresses that more studies are needed to assess outcome and effectiveness related to the use of assistive living technologies, 12–14 but there is a potential to prevent hospitalisations by providing early warnings of exacerbation events or deterioration. This is a significant issue in regard to both quality and cost.…”

Die häufigsten Elektrolytstörungen in der Notaufnahme

“…Ein Problem der bisher genannten Maßnahmen ist, dass es nach der initialen Verschiebung des K + in intrazellulä-rer Richtung innerhalb der nächsten 12-24 h zur Rückkehr des K + in die Zirkulation kommt [7]. Daher muss diese Zeit genutzt werden, um aktiv K + aus dem Kör-per zu eliminieren.…”