case 1 : 60 year old patient with renal failure present with palpitation , dyspnia , hypotension
ecg reveal peaked T wave in chest leads , flat p wave in some lead (also pr prolongation , wide qrs can occur)
serum potassium was 7.1mmol/L(hyperkalemia) , how to manage
: ca gluconate , insulin -glucose , ventolin , furosemide
1-CA gluconate 10% (ampule 1g/10ml) iv slowly over 10 min , repeat dose every 10 min until ecg normalization , if ECG with sine wave , give 3g ca gluconate (3amp)
*(remember if you don't treat sine wave in hyperkalemia you will see the signs of death)
*(remember that no max dose of Ca gluconate in hyperkalemia )
2-insulin + glucose
a-insulin 10 U iv bolus (remember that iv bolus insulin superior to iv infusion
b-glucose : if
RBS > 250mg/dl dont give glucose
RBS 180-250mg/dl give 25cc DW50%
RBS <180mg/gl give 50cc DW50%
the maintenance dose 100cc DW5%/hr
3-nebulized ventolin 20mg(4cc) + 4cc NS
*(remember that ventolin dose in hyperkalemia 4cc 20mg but in asthma 5mg 1cc)
4-Lasix 40mg (2amp) iv slowly (dont give in oliguric patient )
case 2 : 30 years old female with know hx of heart failure , drug history was she taken digoxin
she complain of weakness , irregular pulse , paraesthesia , ecg reveal that peaked p wave , flat T wave (also T wave invrsion ,st depression , prominant U wave can present)
she was had hypokalemia
so according to serum k level
1- mild 3-3.5 (in absence of muscle weakness and arrhythmia)
-oral 10-20meq KCL tab 2-4 times daily
-iv (patient unable to tolerate oral tab) 20meq (1amp) in 500NS infused over 2hr with continuous cardiac monitoring
2-moderate 2.5-3
iv 20meq (1amp) KCL + 500cc NS infused over 1hr with continuous cardiac monitoring
3-severe <2.5 with arrhythmia
2 iv lines (each line with 20meq 1amp +100cc NS with continuous cardiac monitor )
cardiac arrest due to hypokalemia : 1amp 20meq direct iv within 3min
no response to KCL infusion , then give Mg sulphate (2g 1vial + 20cc /20min) then 20meq KCL +500NS over 1hr )