What is hyperkalemia?​

• An excess of potassium (K⁺) in the blood stream​
• It could potentially be caused by the following:​
  • Excessive K⁺ intake (supplements, infusions)​
  • Impaired K⁺ excretion (renal impairment, dialysis)​
  • Medical conditions (CHF, Diabetes, Addison’s disease)​
  • Medications (Beta blockers, NSAIDs, ACE Inhibitors, Diuretics)​
  • Prolonged crush injury

What to know about it:​

• Causes cardiac myocyte dysfunction and therefore can lead to cardiac arrest, as the pumping function fails​
• Can cause characteristic ECG findings, as the myocytes start to malfunction:​
  • Can present with tall, peaked T waves​
  • Eventually, the P wave can flatten, the PR interval can increase, and the QRS can widen (sine-wave) *Note: You may not be able to observe these changes prior to cardiac arrest

In short, available medications and interventions!​

• There are certain medications that may assist in the treatment of hyperkalemia, even in cardiac arrest:​
  • Calcium gluconate​
  • Sodium bicarbonate​
  • Salbutamol ​
  • Furosemide (Unavailable to ACPs)​
  • Insulin (Unavailable to ACPs)​
• Other in-hospital interventions include hemodialysis or ECMO ​
• For ACP scope, in general, if able to add Hyperkalemia Medical Directive treatment to your resuscitation, no early transport is required

In Summary:

• Hyperkalemia can cause lethal cardiac conduction changes​
• If you have a high suspicion for hyperkalemia as a potential cause of cardiac arrest (e.g. medical conditions, medications, clinical context +/- ECG changes)​
  • PCP scope: consider leaving after a minimum of one analysis​
  • ACP scope: Utilize treatments in the Hyperkalemia Medical Directive in conjunction with the Medical Cardiac Arrest Medical Directive. In general, do not need to leave early​
• If there is no clear indication for hyperkalemia, continue with treatment per the Medical Cardiac Arrest Medical Directive, as indicated

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