Hyperkalaemia treatment
KDIGO have just published their conference conclusions on managing acute #hyperkalaemia so I run through some learning points, some criticisms and the bits I’m not sure about as a renal reg.
#medtwitter #nephpearls #meded
Before we start - why do we care?
Because hyperkalaemia associates with a large increase in risk of death in the next 24 hours.
☠️ mortality not necessarily caused by the hyperkalaemia itself, but can indicate that something bad is happening
ncbi.nlm.nih.gov/m/pubmed/19546…
![](https://pbs.twimg.com/media/EPN3VmMXsAAY-V5.jpg)
KDIGO hyperkalaemia treatment algorithm
Key message #tipsfornewdocs
✅ Don’t use potassium-hiding therapies (iv insulin/dextrose and neb) but do nothing else as it’ll just rebound. You must address the underlying cause and consider potassium-eliminating treatments.
![](https://pbs.twimg.com/media/EPN3YJqWkAAfmzb.jpg)
![](https://pbs.twimg.com/media/EPN3YJxWkAMcPI_.jpg)
Algorithm problems IMO
✅ default = iv insulin/dex AND salbutamol
✅ repeat ECG at 5 mins & re-bolus calcium if ECG changes persist (they do mention this in text)
✅ Sodium bicarb 8.4% doesn’t work (solute drag moving K out of cells cancels out benefit of improving pH?)
Further #tipsfornewdocs that is often mismanaged; the dose of B2-agonist is really big compared to COPD/asthma dose
![](https://pbs.twimg.com/media/EPN3YxUWAAUrvIu.jpg)
Here’s the paper. Would love to hear other people’s opinions (or disagreements).
kidney-international.org/article/S0085-…