Management of hyperkalemia in NHGP ( wef 17 October 2011)
K 5.1 to 5.5 (Ensure specimen is not haemolysed):
(HyperKalaemia Protocol)
i) Dietary advice to reduce K intake - use of dietary brochure on how to cut down Potassium intake
ii) HCTZ(when creat <200) or Lasix (when creat > 200), ensure BP >110/70mm Hg
iii) Switch Atenolol to Bisoprolol (cheapest cardioselective b blocker in polyclinics)
K 5.6 to 5.9 (Ensure specimen is not haemolysed):
i) Follow Hyperkalaemia Protocol as for K 5.1 to 5.5
ii) Reduce ACEI/ARB if K>5.5 despite Hyperkalaemia Protocol
iii) Use Resonium 15 g tds for 3 days & repeat K/Creat 1 week later to review
iv) Refer to Nephrologist if despite Hyperkalaemia Protocol, K remains 5.6 to 5.9 (according to new CKD referal critierias)
K >/=6.0 (Ensure specimen is not haemolysed):
(Critical Result)
i) Refer A&E (At A&E, K rechecked, Continuous ECG monitoring, Resonium given if hyperKalaemia confirmed, kiv IV Insulin in Dextrose, kiv IV Ca Gluconate if cardiac arrthmias detected & kiv pt's admission/discharge with SOC/Polyclinic rv)
K 5.1 to 5.5 (Ensure specimen is not haemolysed):
(HyperKalaemia Protocol)
i) Dietary advice to reduce K intake - use of dietary brochure on how to cut down Potassium intake
ii) HCTZ(when creat <200) or Lasix (when creat > 200), ensure BP >110/70mm Hg
iii) Switch Atenolol to Bisoprolol (cheapest cardioselective b blocker in polyclinics)
K 5.6 to 5.9 (Ensure specimen is not haemolysed):
i) Follow Hyperkalaemia Protocol as for K 5.1 to 5.5
ii) Reduce ACEI/ARB if K>5.5 despite Hyperkalaemia Protocol
iii) Use Resonium 15 g tds for 3 days & repeat K/Creat 1 week later to review
iv) Refer to Nephrologist if despite Hyperkalaemia Protocol, K remains 5.6 to 5.9 (according to new CKD referal critierias)
K >/=6.0 (Ensure specimen is not haemolysed):
(Critical Result)
i) Refer A&E (At A&E, K rechecked, Continuous ECG monitoring, Resonium given if hyperKalaemia confirmed, kiv IV Insulin in Dextrose, kiv IV Ca Gluconate if cardiac arrthmias detected & kiv pt's admission/discharge with SOC/Polyclinic rv)