65 year old man had a bowel resection 5 days ago

Discussion in 'Plab 1 and 2 forum' started by Partha Sarkar, Feb 18, 2013.

  1. 65 year old man had a bowel resection 5 days ago. He is anuric and breathless. His BP is 150/110 mmHg. He has crackles at both lung bases and sacral edema. Results: K 6.8 mmol/l, Urea 58 mmol/l, Creatinine 600 umol/l

    Most important management:

    1. Bolus of 20 units insulin
    2. Calcium polystyrene sulphonate (Ca resonium) enema
    3. Dextrose-saline sol
    4. 5% Dextrose infusion
    5. 10 units Insulin, 50 ml of 50% dextrose infusion
  2. Agree, just would like to add that According to GP notebook Management of Hyperkalemia is as follows:

    1. Stop K+ containing infusions
    2. Obtain an ECG and stabilize the heart
    3. Ca gluconate
    4. Administer Iv glucose + Insulin with glucose monitoring.
    5. Ca resonium
    6. Na Bicarbonate

    Insulin stimulates Na+ K+ ATPase pump in skeletal, cardiac and liver muscles, so driving K+ into cells.

    Salbutamol also pushes K into cells.

    Your view about Na bic is correct, but here I think the patient is overload, so cant be administered.
  3. Calcium gluconate IV is actually not for treating the hyperkalemia but for protecting the heart, so it's only used when there's risk/evidence of ECG alterations (ECG changes don't relate well to the level of K, so regardless of how high it is, an ECG should always be done).
    Then, the first line of treatment is insulin + glucose. You can also use nebulized Salbutamol (not too sure if I'd use a Beta agonist in a patient with unstable heart failure, though).
    Bicarb is not used unless there's acidosis, and you need to monitor pH constantly, so some people don't recommend it.
    All these shift K into the cells.
    To remove from the body, you use calcium resines (polystyrene)

Share This Page