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Practice corner: the first symptom of hyperkalaemia is death
  1. Paul Glasziou, MBBS, PhD
  1. Centre for Evidence-Based Medicine, Oxford, UK

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    How do we find out about new useful treatments? For new pharmaceuticals you are likely to be inundated with information and dinners. But for non-pharmaceuticals, complementary medicines, or simple but effective uses of old pharmaceuticals, updates and reliable information are less accessible. This issue’s clinical scenario is set in a busy suburban primary care practice. However, the practice has the still unusual advantage of being computerised, with permanent internet access from the doctor’s desktop.


    An anxious laboratory technician phoned the practice with a serum potassium concentration of 7.3 mmol/l found on a routine blood test of a 50 year old woman. She was not my patient, but because of this test result, she was booked to see me urgently. Recalling a renal physician’s adage that "the first symptom of hyperkalaemia is death," I wondered whether she would turn up and what I should do? When she arrived, I checked her medications to be sure that she wasn’t on any that would raise her potassium, and arranged an urgent repeat of the potassium and other electrolytes (to rule out a spurious elevation and check renal function, etc) and an electrocardiogram (ECG). While I was waiting for the ECG, I decided to do a quick search on the question: Does a normal ECG rule out a serious elevation of potassium?


    For diagnostic accuracy questions, I usually try PubMed: Clinical …

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    • * To pick up all studies on a drug class, I would now find the MeSH term for that class—in this case “adrenergic beta-agonist”—which would have simplified the search by reducting the “hits” to the 8 most relevant articles.