By Dr.

Kousama SJH 2020

Hyperkalemia ECG Changes

‣ Peaked T wave

‣ Prolonged PR interval

‣ ST changes

Objectives: ‣ Wide QRS

1. Notice hyperkalemia (clinically)

‣ May progress to asystole

2. Understand ECG changes

3. Treat hyperkalemia on time

Goals of Rx
“AIRED”
Causes A add calcium

“MACHINE” I increase excretion (Kayexalate, Diuretics)

M medications (ACEIs, NSAIDS..)

R remove source (drugs..)

A acidosis (respiratory or metabolic)

E enhance K+ uptake (Insulin, Glucose,

C cellular damage (burns, trauma..)

NaCO3-..)

H hypoaldostronism, hemolysis
D dialysis

I intake (excessive of potassium)

N nephrons (renal failure)

E excretion (decrease)
Treatment
1. Ca2+ Gluconate (10ml):
‣ 1A IV over 2-3 mn

Signs ‣ Effect lasts 30-60 mn

“MURDER”
‣ If effect does not appear, use one again
M muscle weakness
5 mn later.

U urine (oliguria, anuria)

‣ Effect: prevent from V. Fib

R respiratory distress

‣ But if hyper-K+ from Digitalis (Digoxin)

=> use CaCl2 hydrate 2% (20ml)
D decreased cardiac contractility

2A IV 2-5 mn
E ECG changes

2. Glucose-Insulin:
R reflex (hyperreflexia or areflexia-flaccid)

‣ [Ins. 10 units (0.1ml) 1A] + [Glu. 50%

(10ml) 5A] inj. w/ IV in 30 mn
‣ If BG is 250 mg/dL, no need to IV Glu.

Remember “SHOCK” ‣ Effect appears 30 mn and last 2-6 hr

(shock + bradycardia) 3. Salbutamol:

S spinal cord injury (neurogenic shock)

‣ 10-20 mg by nebulizer over 10 mn

H hypo-endocrine (hypothyroidism, adrenal

‣ To promote k+ uptake into cells

insufficiency, Pituitary apoplexy)

4. NaCO3-:
O osborn (hypothermia)

‣ 1 mEq/kg DIV
C cardiogenic/cardiotoxic

‣ Effect lasts 2 hr
K potassium (hyperkalemia)

When to Start Rx
High risk patient w/ hyperkalemia (clinical
signs):

‣ w/ ECG changes => Rx immediately

‣ w/o ECG changes => confirm ABGs and

start Rx