A 52 year old female with Type 2 Diabetes presents to your OPD with complaints of dizziness and palpitations since last 2 months.
She also complains of muscle weakness , occasional chest pains and numbness in her hands and feet.
On history taking , you note she is non compliant with her diabetes medications which include Metformin 850 mg twice a day.
She is also non compliant with dietary restrictions and does not maintain a record of her sugar levels with glucometer at home.
Her Blood pressure is 154/90 mm Hg and her Random sugar levels are 254 mg/dl.
You decide to conduct and ECG / Electrocardiogram which is shown below :
1 . What are the findings on the ECG ?
2 . What is the cause of her symptoms ?
3. What are the causes of this condition?
4 . How will you manage this condition ?
5. What are the symptoms of this condition ?
6. What are the complications of this condition?
7 . What long term advise should be given to this patient ?
Answers given in comments section.
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3. What are the causes of this condition?
Anyone can get hyperkalemia, even children.
The risk is higher if someone has one of conditions below :
Addison’s disease.
Alcohol use disorder (alcoholism).
Burns over a large part of your body.
Congestive heart failure.
Diabetes.
Human immunodeficiency virus (HIV).
Kidney disease.The most common cause of genuinely high potassium (hyperkalemia) is related to your kidneys, such as:
Acute kidney failure
Chronic kidney disease
Other causes of hyperkalemia include:
Angiotensin II receptor blockers
Angiotensin-converting enzyme (ACE) inhibitors
Beta blockers
Dehydration
Destruction of red blood cells due to severe injury or burns
Excessive use of potassium supplements
4 . How will you manage this condition ?
Treatment varies depending on the potassium level.
Options include:
Diuretics: Also called water pills, these drugs make the patient pee more often. The body gets rid of potassium mainly in urine.
Intravenous (IV) therapy: Extremely high potassium levels need immediate treatment. An IV infusion of calcium gluconate 10 % 10 ml to protect the heart from Arrythmias.
An infusion of insulin 10 units of Actrapid in 50 ml 50% dextrose helps move potassium into the blood cells. Albuterol nebs can also lower potassium levels.
Medication management: Many people see improvement after stopping or changing certain blood pressure medications or other drugs that raise potassium levels.
Potassium binders: A daily medication binds to excess potassium in the intestines. .
Potassium binders come in oral and enema form.
Dialysis: If potassium levels remain high, or patient develops kidney failure, dialysis may be required. This treatment helps kidneys remove excess potassium from blood.
5. What are the symptoms of this condition ?
Many people with mild hyperkalemia have no signs or ones that are easy to dismiss.
Symptoms often come and go and may come on gradually over weeks or months.
Dangerously high potassium levels affect the heart and cause a sudden onset of life-threatening problems.
Hyperkalemia symptoms include:
Abdominal (belly) pain and diarrhea.
Chest pain.
Heart palpitations or arrhythmia (irregular, fast or fluttering heartbeat).
Muscle weakness or numbness in limbs.
Nausea and vomiting.
6. What are the complications of this condition?
Severe hyperkalemia can come on suddenly.
It can cause life-threatening heart rhythm changes (arrhythmia) that cause a heart attack. Even mild hyperkalemia can damage heart over time if not treated.
7 . What long term advise should be given to this patient ?
In this case , the patient has diabetes and is non compliant with medications and diet, she should be counselled about strict dietry compliance and antidiabetic medications to help normalize her sugar levels that will help her Potassium levels as well.
Patient should restrict and avoid foos rich in potassium .
These include :
Asparagus.
Avocados.
Bananas.
Citrus fruits and juices, such as oranges and grapefruit.
Cooked spinach.
Melons like honeydew and cantaloupe.
Nectarines.
Potatoes.
Prunes, raisins and other dried fruits.
Pumpkin and winter squash.
Salt substitutes that contain potassium.
Tomatoes and tomato-based products like sauces and ketchup.
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