Question

A patient on IV Potassium suddenly complains of muscle weakness. Upon assessment, you found that the patient had tachycardia, flaccid paralysis, paraesthesia, abdominal distention, irritability. The ECG values indicated absent P waves, tall tented T waves, prolonged PR interval and QRS duration.

What would be your diagnosis for this patient?

What would be your immediate management for this patient?

Mention any Five (5) medical conditions that can lead to the patient’s diagnosis

Explain the major complication that may occur if not intervened immediately.

Answer 1

The symptoms of the patient reveals that the diagnosis is hyperkalemia ( that is, increased potassium level in the blood )

Symptoms of hyperkalemia are muscle weakness, tachycardia, flaccid paralysis, parasthesia, abdominal distension, irritability.

And ECG with absent P wave, tall tented T waves, prolonged PR interval and QRS duration.

Immediate management of a patient with hyperkalemia are:-

• IV calcium administration ( either calcium gluconate or chloride ):- it reduces the risk of ventricular fibrillation associated with hyperkalemia
• Insulin administration along with glucose:- increases the uptake of glucose into the cells thereby increase the intracellular shift of potassium
• Diuretics:- furosemide ( lasix), bumetanide, hydrochlorothiazide etc helps in lowering potassium level by removing potassium through urine
• Beta2 agonist :- Albuterol inhalation used in nonacute situations of hyperkalemia which helps to reduce potassium by increasing intracellular shift of potassium
• Sodium bicarbonate :- but not considered as a first line management

Medical conditions that can lead to hyperkalemia include :-

1. Acute kidney disease
2. Chronic kidney disease
3. Addison disease :- In this, aldosterone insufficiency causes hyperkalemia. Low aldosterone level causes increased potassium level. Aldosterone is a steroid hormone which helps in the regulation of salt and water in the body.
4. Type 1diabetes:- normally potassium is removed through the urine. But in type 1 diabetes, water retention cause decreased potassium removal and increased blood potassium level
5. Beta blockers:-like propranolol and labetalol cause hyperkalemia. Because it blocks cellular uptake of potassium, thereby increases blood potassium level
6. Dehydration :- it decreases urine output and retention of potassium in blood
7. Angiotensin- converting enzyme inhibitors like Lisinopril, ramipril, captopril

Complications of hyperkalemia

Major complications of hyperkalemia is cardiac arrest and death. It increases the mortality rate. Increased potassium cause suppression of electrical activity of heart and eventually heart stops beating. It is contributed by the entry of calcium and sodium into the myocytes results in cardiac arrest and death. Because this causes cell swelling, acidosis and consumption of ATP (adenosine triphosphate) , thereby triggers programmed cell death.