Resuscitation in special circumstances workshop Life-threatening electrolyte disorders Version: Jun 2016

Learning outcomes At the end of this workshop you should be able to: use a systematic approach to the assess and treat the patient with electrolyte disorders

What is your initial treatment? What investigations will you request? Case study Clinical setting and history A 60-year-old man presents to the ED with a 2-day history of severe diarrhoea and vomiting. His medication includes frusemide and an ACE inhibitor. Clinical course ABCDE A : clear B : RR 20 min-1, SpO2 92% on room air, chest clear on auscultation C : P 130 min-1, BP 80/50 mmHg, cool peripheries D : responds to Voice E : no rashes, looks pale What is your initial treatment? What investigations will you request? 3

Case study (continued) Laboratory results: Reference normal ranges Na+ 130 mmol L-1 135 -145 mmol L1 K+ 7.9 mmol L-1 3.5 - 5.0 mmol L1 urea 29.1 mmol L-1 3.0 - 7.0 mmol L-1 creatinine 841 μmol L-1 60 - 100 μmol L-1

Case study (continued) Reference normal ranges Na+ 130 mmol L-1 135 -145 mmol L1 K+ 7.9 mmol L-1 3.5 - 5.0 mmol L1 urea 29.1 mmol L-1 3.0 - 7.0 mmol L-1 creatinine 841 μmol L-1 60 - 100 μmol L-1 Arterial blood gas results: (patient on high-flow oxygen) Reference normal ranges pH 7.11 7.35 - 7.45 PaO2 135 mmHg > 75 mmHg on air PaCO2 26 mmHg 35 – 45 mmHg bicarbonate 9.0 mmol L-1 22 - 26 mmol L-1 K+ 8.1 mmol L-1 3.5 - 5.0 mmol L-1 Na+ 133 mmol L-1 135 - 145 mmol L-1 What is the diagnosis and what treatments will you start?

Case study (continued) Clinical course the patient is starting to look worse a nurse brings you his 12-lead ECG 6

Case study - What does the 12-lead ECG show?

Case study Clinical course the patient has a cardiac arrest with an initial rhythm of asystole What is the management of cardiac arrest in hyperkalaemia? 8

Any questions?

Advanced Life Support Course Slide set All rights reserved © Australian Resuscitation Council (June 2016)