Transcript K + 7.9 mmol l -1 - the Australian Resuscitation Council

Special Circumstances Workshop
Electrolyte Disorders
Learning outcomes
By the end of this session the candidate will:
• Have a systematic approach to the assess and treat the
patient with electrolyte disorders
Case study
Clinical setting and history
• A 60-year-old man presents to the ED with a 2-day history of severe
diarrhoea and vomiting. His medication includes furosemide and an ACE
inhibitor.
Clinical course
• ABCDE
- A : Clear
- B : RR 20 min-1
- C : P 130 min-1, BP 80/50 mmHg
- D : Responds to Voice
- E : No rashes, looks pale
What is your initial treatment?
What investigations will you request?
Case study (continued)
Laboratory results:
Na+
K+
bicarbonate
urea
creatinine
130 mmol l-1
7.9 mmol l-1
11 mmol l-1
29.1 mmol l-1
841 μmol l-1
Approximate normal ranges
Na+
135 -145 mmol l-1
K+
3.5 - 5.0 mmol l-1
bicarbonate
22 - 26 mmol l-1
urea
3.0 - 7.0 mmol l-1
creatinine
60 - 100 μmol l-1
Case study (continued)
Laboratory results:
Na+
K+
bicarbonate
urea
creatinine
130 mmol l-1
7.9 mmol l-1
11 mmol l-1
29.1 mmol l-1
841 μmol l-1
Approximate normal ranges
Na+
135 -145 mmol l-1
K+
3.5 - 5.0 mmol l-1
bicarbonate
22 - 26 mmol l-1
urea
3.0 - 7.0 mmol l-1
creatinine
60 - 100 μmol l-1
Arterial blood gas results:
pH
7.11
PaCO2 3.5 KPa
PaO2
18 KPa
bicarbonate
9.0 mmol l-1
K+
8.1 mmol l-1
Na+
133 mmol l-1
(patient on high-flow oxygen)
Approximate normal ranges
pH
7.35 - 7.45
PaCO2
4.7 - 6.0 KPa
PaO2
> 10 KPa on air
bicarbonate
22 - 26 mmol l-1
K+
3.5 - 5.0 mmol l-1
Na+
135 - 145 mmol l-1
What is the diagnosis and what treatments will you start?
Case study (continued)
Clinical course
• The patient is starting to look worse
• A nurse brings you his 12-lead ECG
What does the 12-lead ECG show?
Case study (continued)
Case study
Clinical course
• The patient has a cardiac arrest with an initial rhythm of
asystole
What is the management of cardiac arrest in hyperkalaemia?
Hypokalaemia
Causes
• Dialysis and medications/iatrogenic (including excessive IV
fluids)
• Severe diarrhoea +/- vomiting
Treatment
• Treatment depends on severity of hypokalaemia in peri-arrest
• In cardiac arrest
• IV/IO potassium 5 mmol bolus
• IV/IO magnesium 5 mmol bolus
Any questions?
Advanced Life Support Course
Slide set
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©Australian Resuscitation Council and Resuscitation Council (UK) 2010