Zahoor Ahmad.
Hyperkalemia as a medical emergency in patients with ESRD on hemodialysis.
Pak J Med Sci Jan ;26(1):117-22.

Objectives: To see the incidence and clinical presentation of hyperkalemia as a medical emergency in patients with ESRD on hemodialysis and to determine the safety and efficacy of two hours hemodialysis session as an emergency measure for the treatment of this emergency. Methodology: This observational study was conducted in emergency department [ED] and hemodialysis unit [HDU] of Qilwah General Hospital Albaha, Saudi Arabia from Feb 2001 till Jan 2009 [8years].Twenty two patients with ESRD on hemodialysis presenting to ED as a medical emergency due to hyperkalemia were studied to know the clinical presentation of hyperkalemia and ECG changes. Salbutamol nebulisation along with DW 50% 50 ml with regular insulin was used to buy time for dialysis. Calcium gluconate 10% 10ml was given for cardioprotection if indicated. All patients were monitored closely. Serum potassium levels were measured at arrival, after one hour, at completion of two hours of hemodialysis and at 12 hours later. Results: Total 20848 dialysis sessions were done in HDU and 192[0.92%] were as emergency dialysis sessions. Twenty two dialysis were done for hyperkalemia. Shortness of breath was the most common symptom and mean time since last dialysis session was 65.91±16.08 hours. Mean serum potassium at arrival to ED, one hour later, after 2 hours of dialysis and 12 hours later was 7.10±0.39 mmol/L, 6.41 ± 0.38 mmol/L, 3.48 ± 0.37 mmol/L and 4.53 ± 0.47 mmol/L respectively. The mean decrease in serum potassium after medical treatment in ED and after two hours of dialysis was 0.69±0.13 [p value<0.0001] and 2.93±0.12 mmol/L [p value <0.0001] respectively. Two patients died in ED before dialysis could be started. Conclusion: ESRD patients may come to ED with hyperkalemia. If serum potassium is more than 6.0 mmol/L or ECG findings of hyperkalemia are there in these patients, ventolin nebulisation and dextrose-insulin infusion should be given in ED to buy time for an emergency session of dialysis. Calcium gluconate has cardioprotective effect. A two hour dialysis session as an emergency measure is effective and safe in such situations provided it is followed by a scheduled session of dialysis next day. Any delay may prove fatal.

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