Year ear 6 P 6 Pres escribing Hyp yper erkal alae aemia - - PowerPoint PPT Presentation

Year ear 6 P 6 Pres escribing Hyp yper erkal alae aemia

• Using one scenario to discuss the

assessment and management of hyperkalaemia

• Focus on giving you the opportunity to

prescribe for this scenario

Co Conten ents

• To be able to briefly discuss the assessment

and management of hyperkalaemia

• To be

be able ble to

• pre

prescrib ibe app pprop

• priately

ly for r hype yperkalaemia a at th the le leve vel o l of an FY FY1

Objec ectives es

 You are the FY1 in combined assessment. A

patient has been admitted by the registrar in A&E with vomiting and dehydration.

 His bloods are:

• FBC

FBC: Hb 150, WCC 11, Platelets 350

• U&Es:

s: Urea 13, Creatinine 110, Sodium 130, Potassium 7.1

 You have established that the blood sample was

not taken from his drip arm. The patient’s vomiting has settled.

Sc Scen enar ario 1 1

 PMH

MH:

• IHD
• MI’s two years ago and ten years ago

 Medic

icatio tion his istory

• ry:
• Aspirin 75mg orally daily
• Ramipril 10mg orally daily
• Bisoprolol 10mg orally daily
• Co-amilofruse 5/40 one tablet orally daily
• Simvastatin 40mg orally at night
• Spironolactone 50mg orally daily
• Glyceryl trinitrate 800 micrograms sublingually

when required

 No known drug allergies

Bac Backgr kground

 BP 139/78, HR 64, Sats 96% (RA), RR 16, T

37.1

 Respi

piratory ry: unremarkable

 CV

CVS: HS I+II+0, bilateral pitting oedema to knees

 Ne

Neur uro &

• & GI

GI: unremarkable

On E Exam amination

1.

What information and investigations do you want?

2.

What is your immediate management?

3.

What will you prescribe?

Ques estions

 ECG  Hydration status  Signs of cardiovascular instability

Invest stigations

EC ECG

 We need to prescribe

• Calcium gluconate
• Insulin
• Nebulisers
• Any others?

Prescribi bing

 Administer calcium gluconate10%, 10ml slow

IV (over 2 to 3 minutes) – watch ECG while doing it and titrate the dose according to the ECG

 Duration of action is anticipated to be 30 to

60 minutes – repeat if required

Immediate M e Man anag agem emen ent

 Actrapid 10 Units IV in 50mls 50% Glucose

• ver 30 minutes

 Peak effect of insulin glucose is usually seen

within 30 to 60 minutes after the infusion

 This effect may last for several hours with a

rebound in potassium anticipated

Insulin

 Salbutamol 10mg NEB  Unlicensed indication  Cautious use in patients with cardiovascular disease  The effect of nebulised salbutamol can happen

within 30 minutes of administration and may last for 2 hour

Ne Nebulisers

Monito toring

 Recheck potassium level in 2 hours and 6 hours after

treatment

 If unable to obtain a blood sample, an arterial gas

sample would suffice

 Capillary glucose (BM’s) MUST be monitored:

• Every 15 minutes in the first hour
• Every 30 minutes in the second hour
• Every hour thereafter for a total of six hours

 Regular Medications: Withold medications that can cause

hyperkalaemia - ramipril, co-amilofruse and spironolactone

 Use of code for non-administration code 9 – ‘dose witheld on

doctors instructions’

 Maintain treatment of underlying cause(s) of hyperkalaemia as

clinically indicated

 Cation-exchange resins (eg: Oral calcium resonium 15g three

times daily) may be considered in some slow resolving cases and should always be prescribed with lactulose

 Consult the Dietetics team for low potassium dietary advice  Prior to d/c should review the appropriateness of spironolactone

and co-amilofruse (potassium sparing) in light of hyperkalaemia

Other er

• Assessment
• ECG
• Hydration status
• Cardiovascular instability
• Prescribing
• Calcium gluconate
• Insulin/glucose
• Salbutamol

Su Summar ary

Management of Hyperkalaemia in Adults

http://intranet.lothian.scot.nhs.uk/Directory/emerge ncydepartment- rie/DepartmentalProtocols/NEW%20EM%20Guidelines /Hyperkalaemia%20Treatment.pdf Golden rules for prescription writing http://intranet.lothian.scot.nhs.uk/Directory/Medicin esManagement/Documents/Golden%20rules%20fo r%20prescribing%20V%203.1.pdf

Refer eren ences es

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