Metabolic management

Hyperkalaemia may be life-threatening (>6.5mmol/l or ECG changes) and may be prevented by potassium restriction, early dialysis or haemo(dia)filtration. Hypocalcaemia and hyponatraemia are best treated with dialysis and/or haemo(dia)filtration, although calcium supplementation may be used. Hyponatraemia is usually due to water excess although salt-losing nephropathies (acute tubular necrosis, other renal tubular disorders) may require sodium chloride supplements. Hyperphosphataemia may be treated with dialysis, filtration or aluminium hydroxide orally. Metabolic acidosis (not due to tissue hypoperfusion) may be corrected with dialysis, filtration or 1.26% sodium bicarbonate infusion.

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