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Severe ECG changes Calcium counteracts the cardiotoxicity of hyperkalaemia by stabilising the OF HYPERKALAEMIA Treatment Dosage Effect Intravenous calcium Calcium gluconate 10% in 10-mL aliquots iv by ‘slow push’ (2 min) Stabilises myocardial cells and counteracts cardiac toxicity of hyperkalaemia Intravenous insulin and dextrose 10–20 units soluble insulin in 50 mL 50% dextrose infused over 20 min Insulin induces cellular uptake of K+ by activating Na+/K+-ATPase. Dextrose prevents hypoglycaemia Nebulised βadrenergic agonist Salbutamol 5 mg Induces cellular uptake of K+ by activating Na+/K+-ATPase Oral or rectal ionexchange resins Calcium resonium 15 g oral tds Removes K+?

But these are less affected than the kidney and I’m pleased to say that, although some other kinds of amyloid do affect the heart, the kind that you have almost never causes heart trouble. Patient: am I going to die from this? Doctor: you’re right to think that this is a serious condition, and some people with amyloid do die earlier than they would have done otherwise. But at the moment the problem you have is not lifethreatening and many people with this problem will not get worse for years and years.

Treatment of his ankylosing spondylitis may reduce inflammation and thereby his tendency to form amyloid, but this is unlikely to have a dramatic effect and it is expected (1) that he will require continued symptomatic treatment for his oedema and proteinuria; (2) that his renal function is likely to deteriorate with time, even to the point where he requires dialysis, but this is not predictable; and (3) that his amyloid may cause problems with function of other organs in the future, but this also is not predictable.

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