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

Conten Co ents Using one scenario to discuss the • assessment and management of hyperkalaemia Focus on giving you the opportunity to • prescribe for this scenario

Objec ectives es To be able to briefly discuss the assessment • and management of hyperkalaemia To be be able ble to o pre prescrib ibe app pprop opriately ly for r • hype yperkalaemia a at th the le leve vel o l of an FY FY1

Sc Scen enar ario 1 1  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.

Backgr Bac kground  PMH MH: ◦ IHD ◦ MI’s two years ago and ten years ago  Medic icatio tion his istory ory: ◦ 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

On E Exam amination  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 & o & GI GI: unremarkable

Ques estions What information and investigations do you 1. want? What is your immediate management? 2. What will you prescribe? 3.

Invest stigations  ECG  Hydration status  Signs of cardiovascular instability

EC ECG

Prescribi bing  We need to prescribe ◦ Calcium gluconate ◦ Insulin ◦ Nebulisers ◦ Any others?

Immediate M e Man anag agem emen ent  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

Insulin  Actrapid 10 Units IV in 50mls 50% Glucose over 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

Ne Nebulisers  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

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

Other er  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

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

Refer eren ences es 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

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