Hyperkalaemia dogmalysis
One of the things I enjoy most is the dismantling of medical dogma. In his brilliant blog Precious Bodily Fluids, nephrologist Joel Topf reviewed some of the hyperkalaemia literature and offers some of the following pearls:
- The ECG is insensitive and non-specific as a means of diagnosing (and in particular ruling out) hyperkalaemia (sensitivity of ‘strict’ criteria of symmetrical peaked T waves that resolve on follow up: 18%; sensitivity of any ECG change: 52%).
- The dangers of calcium treatment for digoxin toxicity-associated hyperkalaemia may be exaggerated and are supported by very weak evidence
- Sodium bicarbonate does not effectively lower potassium but does lower ionised calcium which can increase the risk of hyperkalaemia-associated dysrhythmia
View Dr Topf’s presentation below:
thanks Cliff
this was really useful as we had a hyperkalaemia induced arrest on the aircraft last week in a septic patient in acute renal failure. so I have been reviewing the current literature around the topic and found your reference quite good. Have you ever used hypertonic saline in hyperkalaemic arrest or tachydysrhythmias? We did in this case last week and it seemed to work well..we had run out of Calcium and bicarb..forgot to give the IV salbutamol though so it was good to review the current management articles.
Great looking blog, enjoyed the articles on amiodarone and epo in STEMI. Keep up the good work and thanks for the plug.
Hi Minh. I’ve heard of HTS for hyperK but haven’t tried it. Cheers – Cliff