Renal: Hyperkalemia: Free MSRA Podcast

✅ MSRA Deep Dive: Hyperkalaemia – Emergency Recognition & ManagementIn this episode, we break down hyperkalaemia — a potentially life-threatening electrolyte imbalance — using a high-yield, structured format designed for the MSRA exam. Learn how to recognise, diagnose, and treat hyperkalaemia effectively using key numbers, clear ECG changes, and a stepwise treatment approach. Based on UK guidelines and core exam knowledge, this is your focused guide to a common emergency you must not miss.🧠 Key Learning Points📌 Definition & Thresholds• Hyperkalaemia = serum K⁺ > 5.5 mmol/L• Severity:Mild: 5.5–5.9 mmol/LModerate: 6.0–6.4 mmol/LSevere: ≥6.5 mmol/L or with ECG changes (medical emergency)📌 Causes• Reduced excretion:AKI, CKDACE inhibitors, ARBs, spironolactone• Redistribution:DKA, acidosis, digoxin toxicity, beta-blockers• Increased load:Potassium supplements, rhabdomyolysis, tumour lysis syndrome, crush injury• Pseudohyperkalaemia:Artefact from hemolysis, prolonged tourniquet, or lab delay📌 Risk Factors• Elderly, diabetics, renal impairment• Dehydration, strenuous exercise, sickle cell trait• Drugs: ACE inhibitors, potassium-sparing diuretics, NSAIDs📌 Pathophysiology• Potassium affects resting membrane potential• Raised extracellular K⁺ makes cells less excitable but slows repolarisation• Leads to muscle weakness, paralysis, and cardiac arrhythmias📌 Symptoms• Often asymptomatic• Muscle weakness → paralysis• Fatigue, palpitations, chest pain• Bradycardia, arrhythmias, respiratory compromise• ECG may be normal despite severe hyperkalaemia📌 ECG ChangesProgression:Tall, tented T wavesProlonged PR intervalLoss of P waveWidened QRSSine wave pattern → Cardiac arrest🛑 A normal ECG does not exclude dangerous hyperkalaemia!📌 Investigations• Repeat potassium to exclude pseudohyperkalaemia• U&Es, creatinine, glucose, FBC, digoxin level• ABG for acidosis and comparison• 12-lead ECG – even if asymptomatic📌 Management FrameworkStep 1: Stabilise Cardiac MembranesIV calcium gluconate (30 mL 10%)Protects the myocardium but does not lower K⁺Step 2: Shift K⁺ IntracellularlyIV insulin (10 units) + glucose (50 mL 50%)Nebulised salbutamol (10–20 mg) as adjunctSodium bicarbonate if acidosis present (after discussion with renal)Step 3: Remove K⁺ from BodyCalcium resonium orally/enemaLoop diuretics (if kidneys working)Dialysis – most effective and definitive method📌 Resistant/Refractory Hyperkalaemia• Repeat insulin-dextrose• Renal referral• Dialysis for life-threatening or resistant cases• Treat underlying cause and stop aggravating drugs📌 Complications• Cardiac arrhythmias (VF, asystole)• Respiratory paralysis• Sudden death• Reversible with prompt recognition and treatment📌 Prognosis• Good if recognised early and managed quickly• Prognosis worsens with delayed diagnosis, renal failure, or recurrent episodes🔗 Hyperkalaemia Revision Resources📄 Revision Notes: https://www.passthemsra.com/topic/hyperkalaemia-revision-notes/💬 Flashcards: https://www.passthemsra.com/topic/hyperkalaemia-flashcards/🧠 Accordion Q&A: https://www.passthemsra.com/topic/hyperkalaemia-accordion-qa-notes/📝 Rapid Quiz: https://www.passthemsra.com/topic/hyperkalaemia-rapid-quiz/📚 Course Hub: https://www.passthemsra.com/courses/renal-for-the-msra/🏷️ Hashtags#MSRA #MSRARevision #Hyperkalaemia #MSRANotes #MSRAFlashcards #MSRAQuiz #ECGChanges #RenalMedicine #MedicalRevision #PassTheMSRA #FreeMSRA #UKGuidelines #MedicalEmergency