A comparative study of different modalities used in the emergency treatment of hyperkalaemia in patients with renal failure at the Kenyatta National Hospital
Abstract
70 patients with acute renal (10 patients) and chronic renal (60 patients) failure with
hyperkalaemiawere managed at the Kenyatta National Hospital (KNH) medical wards and Renal
Unit between August 1995 and January 1996. The patients were divided into 7 different
trearrnenr groups, each consisting of 10 patients. Treatment A group had glucose 25g i.v. with
insulin10 units i.v., Treatment B group had 50 mmol 8.4% Sodium bicarbonate infusion.
TreatmentC group had 0.5 mg salbutamol i. v. in 50 rnls 5% Dextrose, Treatment D group a
combinationof treatments A and B, Treatment E group had a combination of treatments B and .
C, Treatment F group had a combination of treatments A and C, Treatment G group had a
combinationof treatments A and Band C.
Serum potassium was measured, 30 minutes, 1 hour, 2 hours, 4 hours and 8 hours after
treatment. Plasma glucose concentration was measured before treatment and at 1 hour after in
all patients. Electrocardiography was done before treatment on all patients and repeat ECG was
done 30 minutes and 1 hour after treatment for the patients with features of hyperkalaemia on
the initial ECG.
All the treatment modalities had satisfactory potassium lowering effect. The single treatment
modalities A, Band C had a decrease in mean serum potassium at 1 hour of 1.14 + 0.66
mmollL (p < 0.001),0.57 + 0.22 mmollL (p < 0.001) and 1.03 + 0.41 mmollL (p < 0.001)
respectively. Results of treatments A and C were comparable. Treatment B induced the
smallest decrease in potassium at 1 hour and also at all the other time intervals. Amongst the
nearmentmodalities combinations D, E, F the decrease in mean serum potassium at 1 hour
was 1.18 ± 0.50 mmollL (p < 0.00l), 0.82 + 0.40 mmollL (p < 0.001) and l.39 ± 0.66
mmollL (p < 0.001) respectively. Treatment E induced the smallest decrease in potassium at
1 hour and also at all the other time intervals of the 2 treatment modalities combinations.
Treatment E induced a lower decrease in mean serum potassium at all the time intervals
comparedto treatment C. Treatments D and F induced greater decreases in mean serum
potassiumat all time intervals when compared to the single treatment modalities. Treatment G
hadthe greatest decrease in mean serum potassium at 1 hour of L54 + 0.59 mmollL (p <
0.001) and at all the other different time intervals when compared to the other treatment
modalities.
Treatment A induced a significant decrease (p < 0.05) in the repeat plasma glucose
concentration. 20% of the patients managed on treatment A had hypoglycaemia. Treatment B
did not cause a significant decrease (p = 0.648) in the repeat plasma glucose concentration.
Treatments C, E, F and G induced a significant increase (P < 0.01) in the repeat plasma
glucose concentrations. Treatment D included a significant decrease (p < O.OS) in the repeat
plasma glucose concentration, but no patient had hypoglycaemia.
The ECG features of hyperkalaemia did not correlate well with the serum potassium levels. The
main changes on the features of hyperkalaemia on ECG occurred within the first 30 minutes
after treatment.
Xl
Insulin with glucose and salbutamol were equally efficacious in lowering serum potassium in
hyperkalaemia. The effect of the 2 treatment modalities combined was synergistic and seemed
[0 protect against insulin induced hypoglycaemia. Combination of all 3 treatment modalities had
themost efficacious result and seemed to prevent against insulin induced hypoglycaemia as well.
The combination of salburamol and sodium bicarbonate was not synergistic.
Citation
Degree of Master of Medicine (Internal Medicine) in the University of NairobiPublisher
University of Nairobi School of Medicine
Description
A dissertation submitted in partial fulfillment
for the Degree of Master of Medicine (Internal
Medicine) in the University of Nairobi