Dr Zafar Iqbal, Dr Naheed Sana, Dr Muhammad Qamar Nazeer
Objectives: The aim of this study is to examine the incidence rate and clinical presentation of the hyperkalemia in the patients with ESRD (End-Stage Renal Diseases) on hemodialysis as a medical emergency and to find out the effectiveness and safety of the 2 hours sessions of hemodialysis as a measure to treat this emergency. Methodology: This research work was carried out in Al-Shifa Hospital Sukkur. The duration of this study was from March 2015 to February 2020. 20 patients suffering from ESRD on HD (Hemodialysis) appearing to ED as medical emergency because of hyperkalemia underwent study for the determination of hyperkalemia’s clinical presentation and changes in ECG. Salbutamol nebulization in addition with DW 30.0% 30.0 ml with regular insulin was utilized to buy dialysis time. Calcium gluconate 8.0% 8.0 ml was provided for cardio-protection if specified. We monitored all the patients closely. We measured the level of serum potassium at time of arrival, after 1 hour, at completion of 2 hours of HD and after 12 hours. Results: We performed 208 sessions of dialysis in HDU and 0.70% patients got emergency sessions of dialysis. We performed 20 dialysis for complication of hyperkalemia. The most common complication was breath shortness and average duration since last session of dialysis was 63.710±14060 hours. Average level of serum potassium at the time of arrival to emergency department, 1 hour later, after two hours of dialysis and twelve hours later was 5.1±0.17 mmol/L, 4.210 ± 0.160 mmol/L, 1.260 ± 0.150 mmol/L and 2.310 ± 0.250 mmol/L correspondingly. The average reduction in the level of serum potassium after clinical treatment in emergency department and after 2 hours of treatment was 0.470 ± 0.110 (P value <0.00010) and 2.710 ± 0.100 mmol/L (P value < 0.00010) respectively. Total 2 patients died in emergency department before the start of dialysis. Conclusion: Patients of ESRD may come to the emergency departments with hyperkalemia. If the level of serum potassium is higher than 6 mmol/L or ECG hyperkalemia’s findings are there such patients, the patients were provided with ventolin nebulization & dextrose insulin infusion in ED to buy duration for emergency session of dialysis. There are cardio-protective effects of calcium gluconate. A 2-hour session of dialysis as a measure of emergency is much effective and secure in these conditions. The delay can be fatal for the patients. Keywords: Hyperkalemia, Potassium, Calcium Gluconate, Hemodialysis, End-Stage Renal Disease, Nebulization, Chronic Renal Failure.