A girl presented with severe hyperkalemia and peaked Twaves on ECG. Most rapid way to decreased serum potassium level.-
Management Treatment of hyperkalaemia depends on its severity and the rate of development, but opinions vary as to what level ofserum potassium constitutes severe hyperkalaemia and requires urgent treatment. Patients who have potassium concentrations <6.5 mmol/L in the absence of neuromuscular symptoms or ECG changes can be treated with a reduction of potassium intake and correction of predisposing factors. However, in acute and/ or severe hyperkalaemia (plasma potassium >6.5-7.0 mmol/L), more urgent measures must be taken . The first step should be infusion of 10 mL 10% calcium gluconate to stabilise conductive tissue membranes (calcium has the opposite effect to potassium on conduction of an action potential). Measures to shift potassium from the ECF to the ICF should also be applied, as they generally have a rapid effect and may ave arrhythmias. Ultimately, a means of removing potassium from the body is generally necessary. When renal function is reasonably preserved, loop diuretics (accompanied by intravenous saline if hypovolaemia is present) may be effective. In renal failure, dialysis may be required. Oral ion exchange resins, such as sodium polystyrene sulfonate (SPS), have traditionally been used to bind and excrete gastrointestinal potassium. Thereare concerns, however, with regard to SPS's lack of proven efficacy and safety, with a number of repos of intestinal necrosis associated with its use. Alternative cation exchanges have been developed and are currently being trialled, with the aim of providing more effective and safer alternatives for the treatment of hyperkalaemia. Ref Davidson 23rd edition pg 363
Calcium gluconate IV
Oral resins
Insulin + glucose
Sodium bicarbonate
Fluid and electrolytes