Hyperkalemia

[kohlerrf]

Does anyone else treat for Hyperkalemia in a living breathing patient and not just as one of the 5 H's. We use Albuterol, Bicarb, Calcium and sometimes Lasix.

[paramedicmike]

How are you measuring their potassium levels?

[croaker260]

We do the same, hyperK is presumptive based on a combination of Hx of renal fauilure or other etiology, and EKG changes.

[scubanurse]

How far out from an ER are you guys when you're treating hyperkalemia in the field? I haven't heard of it as a field treatment before and I'm really curious. I'm on a cardiac tele floor now for advanced med/surg and pretty much all of my patients have hypokalemia so it's something I am studying right now.

[Fenta]

Here it is the same I have never seen that one of our emergency physicians or Paramedics treat a hyperclycämia in the field.

[kohlerrf]

My service does not figure in transport time to the ER if the pt needs it you are suppose to do it regardless of where you are.

We qualify patients the same way that Croaker260 does

My concern is that we use the low dose Albuterol(for bronchial spasm) and subsequently we cant physically get the 10-15 mg into the before and there is resistance of the doctors to giv us the high dose Albuterol for what reason I don't know. In addition being that Calcium is the lynch pin in this protocol we only carry Calcium Chloride on the truck and they wont give us Gluconate either, why again I don't know but the problem here is that the Doc's only rarely give us the order for drip in Calcium because, it is Chloride and not Gluconate. I understand to dnagers of "Rock Heart", although remote, but why not just give us Gluconate which is relatively speaking much safer?

[paramedicmike]

Have you asked the docs why? It seems that your hang up is with the position of your medical command docs. Perhaps your best answers would be received from them.

[scubanurse]

My service does not figure in transport time to the ER if the pt needs it you are suppose to do it regardless of where you are.

I only asked because a lot of times, protocols are based on location. There is a big difference in the care you will provide if you are 30 minutes from a hospital versus <5 minutes...

[chbare]

If you suspect clinically significant hyperkalemia, you should treat it within your capabilities regardless of your transport time. This is where obtaining a good history will come in handy. Remember, not everybody has the classic T wave changes associated with hyperkalemia. History and overall clinical presentation should guide your therapy. Clearly, you can use point of care testing in the rare situation that it may be available.

Regarding calcium chloride and gluconate. Administering Calcium inappropriately can be dangerous regardless of the preparation. The big thing to remember is that Calcium chloride contains over three times the number of Ca++ ions when compared to Calcium gluconate on a gram to gram basis. (Gluconate ~4.7 mEq/g & Chloride ~14 mEq/g). You will need to adjust the amount you administer accordingly. Also remember, while Calcium is the front line, life saving intervention (stabilises the membrane potential), it is only stop gap and you can expect to buy your self less than an hour or so.

The general rule of thumb to follow when treating significant hyperkalemia is the following:

1) Stabilise the membrane potential (Calcium)

2) Shift Potassium into the cells (Insulin/Dextrose, Sodium-bicarbonate, albuterol)

3) Eliminate Potassium from the body (Sodium/Potassium exchange resins [Highly debatable], dialysis, potassium wasting diuretics)

4) Identify underlying causes and treat accordingly

[kohlerrf]

I only asked because a lot of times, protocols are based on location. There is a big difference in the care you will provide if you are 30 minutes from a hospital versus <5 minutes...

No there is not. But this is off topic although it sounds like the start of a great thread;-)

If you suspect clinically significant hyperkalemia, you should treat it within your capabilities regardless of your transport time. This is where obtaining a good history will come in handy. Remember, not everybody has the classic T wave changes associated with hyperkalemia. History and overall clinical presentation should guide your therapy. Clearly, you can use point of care testing in the rare situation that it may be available.

Regarding calcium chloride and gluconate. Administering Calcium inappropriately can be dangerous regardless of the preparation. The big thing to remember is that Calcium chloride contains over three times the number of Ca++ ions when compared to Calcium gluconate on a gram to gram basis. (Gluconate ~4.7 mEq/g & Chloride ~14 mEq/g). You will need to adjust the amount you administer accordingly. Also remember, while Calcium is the front line, life saving intervention (stabilises the membrane potential), it is only stop gap and you can expect to buy your self less than an hour or so.

The general rule of thumb to follow when treating significant hyperkalemia is the following:

1) Stabilise the membrane potential (Calcium)

2) Shift Potassium into the cells (Insulin/Dextrose, Sodium-bicarbonate, albuterol)

3) Eliminate Potassium from the body (Sodium/Potassium exchange resins [Highly debatable], dialysis, potassium wasting diuretics)

4) Identify underlying causes and treat accordingly

I agree it just seems frustrating when we are the give the task and required to gain the knowledge and held accountable they don't give us the best tool to do the job even though it is readily available and only a stroke of a pen stopping it from happening?#@$$%