Electrolytes / DDI / High Risk Meds

Hyperkalaemia >5mmol/L - THANKS, B + Others

Trimethoprim

Heparins

ACEi / SRBs

NSAIDs

K-sparing diuretics

Beta blockers

Others: Penicillins, Tacrolimus, Ciclosporin, Antifungals

Hyperkalaemia Sx + Tx?

Weakness, muscle spasms, lower BP + pulse, arrhythmia, seizures + low respiratory rate

Mild – Moderate Hyperkalaemia (5.5 – 6.4 mmol/L)

-              Short term: calcium resonium

-              Persistent hyperkalaemia with serum conc > 6.5mmol/L (gradual): Patiromer 

Acute Severe Hyperkalaemia (> 6.5mmol/L)

-              IV calcium chloride 10% over 5mins / calcium gluconate 10% over 10mins

-              IV insulin-glucose (10 units soluble insulin in 25g glucose) over 5-15mins followed by 10% glucose IV at 50ml/hr for 5hrs in pts with blood glucose <7.0 mmol/L

-              Nebulised salbutamol 10-20mg

Give all 3 for acute severe hyperkalaemia

Hypokalaemia - ABCDE I + Treatment

Aminophylline / Theophylline

Beta agonists

Corticosteroids

Diuretics - Loops / Thiazides

Erythromycin / Clarithromycin

Insulin

Mild - Moderate: Sando-K (KCl + K bicarbonate)

Severe: IV KCl

Hyponatraemia - These Certain Drugs Ditch Salt + Tx?

TCAs

Carbamazepine

Diuretics

Desmopressin / Vasopressin

SSRIs

Mild: Review meds

Moderate: IV hypertonic NaCl solution

Hypernatraemia: Salty CEO Like Toffee + Tx?

Sodium bicarbonate / chloride

Corticosteroids

Effervescent formulations

Oestrogen / Androgen

Lithium

Tolvaptan

Mild + Moderate: Oral water / IV glucose 5%

Severe: hypotension = IV 0.9% NaCL solution / no hypotension = IV glucose 5%

Hypocalcaemia: Bloods Provide Patient’s Calcium Levels + Tx?

Bisphosphonates

Phosphonates

Phenytoin

Calcitonin

Loop diuretics

Mild: Oral calcium + Vit D (if deficient)

Severe: IV calcium gluconate

Hypercalcaemia: VITAL + Tx?

Vitamin A

Intake of Vitamin D (high doses)

Thiazide diuretics

Antacids containing calcium

Lithium

Mild: Discontinue drugs + restrict dietary calcium

Moderate: IV Bisphosphonate (Zolendronic acid) + Pamidronate disdodium

• Glucocorticoids

• Calcimimetics or parathyroidectomy

Hyperparathyroidism Tx?

IV fluids

1st line Surgical parathyroidectomy

2nd line: Medical Management: Cinacalcet / Bisphoshonates

Hypomagnesaemia: Drugs + Tx?

Aminoglycosides, Loops + Thiazide diuretics, PPIs, Tacrolimus

Mild: Oral magneisum replacement - magnesium sulfate

Severe: IV magnesium sulfate

Hypermagnesaemia: Antacids + Tx?

Antacids

Tx: IV sodium glycerophosphate

Tx for Hypophosphataemia + Hyperphosphataemia

Hypophosphataemia

Moderate: Oral phosphate supplements

Severe: IV Sodium glycerophosphate

Hyperphosphataemia

1st line: Phoshate binder - calcium acetate

2nd line: Sevelamer carbonate