Thinking Fast on Hyperkalemia

Hi all.  This Dr. C filling in for Natalie today.  We had great discussions at Rapid Fire Morning Report today.

On the topic of heuristic thinking and biases here is the reference to the book Dr. Abrams brought up by Daniel Kahneman.  It's a fascinating read.

We also discussed bronchiectasis and the choice of antibiotic treatment in an exacerbattion. As Dr Sibbald mentioned, the British Society Guidelines recommend Amoxicillin as first line (often in high doses), with the caveat that previous cultures should guide therapy.  This is especially true for coverage of Pseudomonas. We did not delve into treatment of non tuberculous mycobacteria, but here is a BTS reference  as well as a more recent ATS guideline for further reading.

Lastly we had a great discussion on managing hyperkalemia.  Here is a link to an interesting article that highlights an important point that came up in our discussion:
- Up to 50% of patients with K>6.5 may have no ECG changes!! Often this is related to chronicity, with slower rises in potassium causing less ECG changes, however that level of hyperkalemia requires prompt treatment.

Finally take a look at the CMAJ article on treatment of hyperkalemia from 2010.

Cheers