All right, so welcome back to the IBCC podcast. I'm here with Adam Thomas, and we're going to

discuss critical hypercalaemia, probably the most dangerous and one of the most common

electrolyte problems they're going to see. You mean we see hypercalaemia a lot? Josh, is that a thing?

Just a little bit. Every once in a while. Just a little bit.

So guys, this is going to be a high-yield podcast because this is something that you need to know cold.

So today we're going to cover the diagnosis of hypercalaemia. Then we'll go over those causes.

We'll talk about risk stratification and that will guide your treatment. That will cover is the mild to moderate approach and then the severe hypercalemic approach. We'll

follow that off with the pitfalls as usual. So Josh, why don't you start us off? Why is the diagnosis

of hypercalemia so ambiguous when we're taught it? Some people say, you know, six is fine. Some say

5.7 is fine. I think it's kind of vague in my mind of when I should really be worrying about

this. So give me a clear approach to diagnosis. What do I need to look at first? And why is that

important? Yeah, no, I agree with you, actually. If you look at different sources, everyone has

slightly different definitions of exactly what critical hyperkillemia is. And we'll discuss it a bit

later below, but it's a little tricky

to parse out exactly where the boundary is between mild, moderate, or severe. So as you say in the

notes, then the money is in the EKG? You want to know, is this immediately life-threatening? So how do I

take a look at that EKG? Yeah, so probably the most common thing that you'll see on the EKG or your classical peaked T-waves.

Other findings can include widening of the QRS complex.

The P-wave can become smaller.

You can get a ventricular tachycardia mimic, where folks are kind of tachycardic and they have a wide

QRS complex.

And finally, right before the patients die, they can develop a sine wave pattern.

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