Medical specialists urgently need more knowledge on how to treat and manage hyperkalaemia (too much potassium in the blood), which may cause respiratory muscle weakness and potentially fatal heart rhythm disturbance.
This is according to Dr Yazied Chothia, senior lecturer and nephrologist in the Division of Nephrology in the Department of Medicine at Stellenbosch University (SU) that they have found that there is a paucity of data on the knowledge and practice patterns of medical specialists regarding the emergency management of hyperkalaemia.
Chothia said, there is a lack of consensus regarding the best way to manage it, which may result in wide variations in practice and the guidance provided to junior staff.
Chothia conducted the research with colleagues Prof Usuf Chikte (Division of Health Systems and Public Health, Department of Global Health) and Dr Razeen Davids (Division of Nephrology, Department of Medicine).
They conducted the first comprehensive survey in South Africa among specialists in nephrology, internal medicine, emergency medicine and critical care medicine to evaluate their knowledge regarding the diagnosis and management of hyperkalaemia, with a focus on insulin-based therapy.
Insulin-based therapy is the most favoured pharmacological method for treating hyperkalaemia. Dextrose (a type of sugar) is usually co-administered to prevent low blood sugar (hypoglycaemia).
“Our aim was to identify knowledge gaps and to inform the development of learning resources to guide the optimal management of this life-threatening condition.
“These included tented T waves as the most common electrocardiogram (ECG) change (change in heart rhythm) to trigger therapy, the time for the potassium concentration to reach its nadir following insulin administration, whether the potassium concentration would return to its pre-shift value and when this was expected to occur, defining resistant hyperkalaemia, and the expectation and surveillance of hypoglycaemia following insulin-based therapy,” the group said.
The findings of their study were also published recently in the African Journal of Nephrology and according to the researchers, various recommendations exist regarding the dosing, sequence and rates of administration for insulin and dextrose to treat hyperkalemia.
They identified important shortcomings regarding the knowledge and management of hyperkalaemia among medical specialists.
“Two-thirds of respondents routinely performed an ECG before deciding whether a patient required treatment for hyperkalaemia, with more non-nephrologists performing an ECG. Nearly three-quarters of respondents thought that there was a poor correlation between potassium and the presence of ECG changes,” the group added.
The group went on to say, fewer than half of the respondents were aware that serum potassium would reach its nadir at 60 minutes after insulin was administered and less than two-thirds indicated that they anticipated the potassium value to return to its pre-shift value. Only a third expected this to occur at 4–6 hours following insulin therapy.
“Of concern was the low expectation of hypoglycaemia by respondents, with only 14% anticipating hypoglycaemia between 2–3 hours after insulin had been administered and 22% indicating that hypoglycaemia was uncommon if dextrose was co-administered. Only 30% checked the glucose concentration in the blood at two hours, and only 22% at three hours, ” the group mentioned.
Meanwhile, their study also emphasises the need to address knowledge gaps, particularly around the optimal and safe use of insulin-based therapies.