The nurse overhears your muttering under your breath.

“Doctor, that’s hyperkalemia on the ECG.”

The porter takes a look too:

“Yes, definitely hyperkalemia.”

Finally, the patient has a look:

“That’s hyperkalemia, with tall tented T waves. The QRS may widen, and the P wave flatten with a prolonged PR interval. Think of it like a piece of string being stretched to the left (shallow P wave, long PR interval, wide QRS) and squashed up on the right (tall tented T waves). Anyway, I’d best get back to being peri-arrest so you professionals can look after me. I mean, what do I know?”

Score: 1/10 – the patient actually gave you the diagnosis. You should not be giving more than 40mmol KCl per 1 litre (which you weren’t doing in this case ), and this amount of potassium (40mmol KCl) must not flow into the veins faster than over 1 hour (which you were doing in this case). Potassium is not given in the first bag of fluids in DKA anyway, and whenever potassium is used IV, rapid changes in the concentration of potassium are avoided by sticking to these limits. Remember that the lethal injection for executions works by infusing potassium IV at faster rates than these limits.

It may be worth refreshing the DKA guidelines.

How to deal with hyperkalemia: