Hyperkalemia, indication, symptoms sign and treatment in dialysis pati

Hyperkalemia, indication, symptoms sign and treatment in dialysis patients, create poster

Reading File

Finding Sources

Reading File

Searching Images

hyperkalemia ECG changes peaked T waves

Running Command

ls -la /home/daytona/workspace/

Running Command

mkdir -p /home/daytona/workspace/hyperkalemia-poster

Writing File

~/hyperkalemia-poster/create_poster.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// Fetch ECG image
const ecgUrl = "https://cdn.orris.care/cdss_images/HARRISON_1763035190062_9442e535-00aa-4301-95a3-fa6fd8faf8bf.png";
let ecgImages = [];
try {
  ecgImages = JSON.parse(
    execSync(`node /home/daytona/skills/shared/scripts/fetch_images.js "${ecgUrl}"`).toString()
  );
} catch (e) {
  console.error("Image fetch failed:", e.message);
}

const pres = new pptxgen();
pres.layout = "LAYOUT_4x3"; // 10" × 7.5" — portrait-friendly poster

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  darkNavy:  "0D1B2A",   // dominant background
  teal:      "0A8A8A",   // accent header
  amber:     "F4A228",   // highlight / caution
  red:       "C0392B",   // danger / critical
  white:     "FFFFFF",
  lightGray: "D8E4EE",
  midGray:   "8FAABB",
  panelBg:   "112233",   // slightly lighter panel
  greenBg:   "0E4B3A",   // treatment panel
};

// ─── SLIDE ───────────────────────────────────────────────────────────────────
const slide = pres.addSlide();

// Full background
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 10, h: 7.5,
  fill: { color: C.darkNavy },
  line: { type: "none" },
});

// ── TOP HEADER BAR ────────────────────────────────────────────────────────────
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 10, h: 0.85,
  fill: { color: C.teal },
  line: { type: "none" },
});

slide.addText("HYPERKALEMIA IN DIALYSIS PATIENTS", {
  x: 0, y: 0, w: 10, h: 0.85,
  fontSize: 24, bold: true, color: C.white,
  align: "center", valign: "middle", fontFace: "Calibri",
  charSpacing: 3,
});

// ── SUBTITLE ─────────────────────────────────────────────────────────────────
slide.addText("Indication for Dialysis  •  Clinical Presentation  •  Emergency Treatment", {
  x: 0, y: 0.85, w: 10, h: 0.32,
  fontSize: 9.5, color: C.lightGray, align: "center", valign: "middle",
  fontFace: "Calibri", italic: true,
});

// ── HELPER: panel background ──────────────────────────────────────────────────
function addPanel(slide, x, y, w, h, color) {
  slide.addShape(pres.ShapeType.rect, {
    x, y, w, h,
    fill: { color: color || C.panelBg },
    line: { color: C.teal, pt: 1 },
    shadow: { type: "outer", color: "000000", opacity: 0.4, blur: 4, offset: 2, angle: 45 },
  });
}

// ── HELPER: section heading ───────────────────────────────────────────────────
function addSectionHeading(slide, text, x, y, w, accentColor) {
  slide.addShape(pres.ShapeType.rect, {
    x, y, w: w, h: 0.28,
    fill: { color: accentColor || C.teal },
    line: { type: "none" },
  });
  slide.addText(text, {
    x, y, w, h: 0.28,
    fontSize: 10.5, bold: true, color: C.white,
    align: "center", valign: "middle", fontFace: "Calibri",
    margin: 0,
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// COLUMN 1  (x=0.12, w=2.9)  — INDICATIONS + EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════════════════
const col1x = 0.12, col1w = 2.9;
let cy = 1.26;

addPanel(slide, col1x, cy, col1w, 2.6, C.panelBg);
addSectionHeading(slide, "⚠  INDICATIONS FOR DIALYSIS", col1x, cy, col1w, "7B3030");
cy += 0.28;

const indications = [
  { h: "Severe hyperkalemia", b: "K⁺ > 6.5 mEq/L or K⁺ > 6.0 with ECG changes, especially when refractory to medical therapy" },
  { h: "Acute kidney injury (AKI)", b: "Hypercatabolic AKI — rapid K⁺ rise, no urinary excretion possible" },
  { h: "Unresponsive to treatment", b: "Persistent hyperkalemia despite insulin, calcium, bicarbonate, and K⁺ binders" },
  { h: "Additional criteria", b: "Volume overload, uremic symptoms, metabolic acidosis" },
];
let iy = cy + 0.08;
indications.forEach(item => {
  slide.addText([
    { text: item.h + " — ", options: { bold: true, color: C.amber } },
    { text: item.b, options: { color: C.lightGray } },
  ], {
    x: col1x + 0.12, y: iy, w: col1w - 0.22, h: 0.44,
    fontSize: 8, valign: "top", fontFace: "Calibri",
    bullet: { code: "25B6", color: C.teal },
  });
  iy += 0.52;
});

// Dialysis removes K stats box
cy = 1.26 + 2.6 + 0.1;
addPanel(slide, col1x, cy, col1w, 1.05, "102030");
slide.addText([
  { text: "Hemodialysis removes ~25–50 mEq K⁺/session\n", options: { bold: true, color: C.amber, breakLine: true } },
  { text: "Dialysate K⁺ 0–2 mEq/L recommended in severe cases\n", options: { color: C.lightGray, breakLine: true } },
  { text: "Peritoneal dialysis: slower but continuous K⁺ removal", options: { color: C.lightGray } },
], {
  x: col1x + 0.1, y: cy + 0.08, w: col1w - 0.18, h: 0.85,
  fontSize: 8, fontFace: "Calibri", valign: "top",
});

// Fasting risk box
cy += 1.05 + 0.1;
addPanel(slide, col1x, cy, col1w, 0.9, "1A1030");
slide.addText("FASTING RISK IN DIALYSIS PATIENTS", {
  x: col1x, y: cy, w: col1w, h: 0.22,
  fontSize: 8.5, bold: true, color: C.amber, align: "center",
  fontFace: "Calibri", margin: 0,
});
slide.addText("Fasting >8–12 h → ↓ insulin → K⁺ shifts out of cells → can't be excreted → life-threatening hyperkalemia. Prevent with IV dextrose (± insulin if diabetic).", {
  x: col1x + 0.1, y: cy + 0.22, w: col1w - 0.18, h: 0.6,
  fontSize: 7.5, color: C.lightGray, fontFace: "Calibri", valign: "top",
});

// ═══════════════════════════════════════════════════════════════════════════════
// COLUMN 2  (x=3.16, w=3.2)  — SYMPTOMS & SIGNS + ECG
// ═══════════════════════════════════════════════════════════════════════════════
const col2x = 3.16, col2w = 3.2;
cy = 1.26;

addPanel(slide, col2x, cy, col2w, 1.65, C.panelBg);
addSectionHeading(slide, "🩺  SYMPTOMS & SIGNS", col2x, cy, col2w, "2E5E8A");
cy += 0.28;

const symptoms = [
  ["Cardiac", "Palpitations, bradycardia, ventricular fibrillation, cardiac arrest"],
  ["Neuromuscular", "Muscle weakness, flaccid paralysis, respiratory failure"],
  ["GI", "Nausea, vomiting, ileus, abdominal cramps"],
  ["Metabolic", "Type IV RTA (impaired H⁺ excretion), endogenous aldosterone ↑"],
];
let sy = cy + 0.06;
symptoms.forEach(([sys, desc]) => {
  slide.addText([
    { text: sys + ": ", options: { bold: true, color: C.amber } },
    { text: desc, options: { color: C.lightGray } },
  ], {
    x: col2x + 0.12, y: sy, w: col2w - 0.22, h: 0.33,
    fontSize: 8, fontFace: "Calibri", valign: "top",
    bullet: { code: "2022", color: C.red },
  });
  sy += 0.33;
});

// Critical note
cy = 1.26 + 1.65 + 0.06;
slide.addText("⚡ Often CLINICALLY SILENT until life-threatening arrhythmia! Always obtain ECG.", {
  x: col2x, y: cy, w: col2w, h: 0.28,
  fontSize: 8, bold: true, color: C.white, align: "center",
  fill: { color: C.red }, fontFace: "Calibri", margin: [0, 4, 0, 4],
});

// ECG section
cy += 0.28 + 0.06;
addPanel(slide, col2x, cy, col2w, 1.42, C.panelBg);
addSectionHeading(slide, "📈  ECG PROGRESSION", col2x, cy, col2w, "1A5C7A");
const ecgData = [
  ["Mild (5.5–6.5)", "Peaked / tented T waves"],
  ["Moderate (6.5–7.5)", "↓ P wave amplitude, widened PR"],
  ["Severe (> 7.5)", "P wave disappears, wide QRS"],
  ["Critical", "Sine-wave pattern → VF / asystole"],
];
let ey = cy + 0.32;
ecgData.forEach(([level, finding]) => {
  slide.addText([
    { text: level + " mEq/L: ", options: { bold: true, color: C.amber } },
    { text: finding, options: { color: C.lightGray } },
  ], {
    x: col2x + 0.12, y: ey, w: col2w - 0.22, h: 0.24,
    fontSize: 8, fontFace: "Calibri",
    bullet: { code: "25BA", color: C.teal },
  });
  ey += 0.24;
});

// ECG image
cy += 1.42 + 0.06;
if (ecgImages.length && !ecgImages[0].error) {
  slide.addImage({
    data: ecgImages[0].base64,
    x: col2x, y: cy, w: col2w, h: 1.62,
  });
  slide.addText("ECG changes with progressive hyperkalemia (Harrison's, 21e)", {
    x: col2x, y: cy + 1.62, w: col2w, h: 0.18,
    fontSize: 6.5, italic: true, color: C.midGray, align: "center", fontFace: "Calibri",
  });
} else {
  addPanel(slide, col2x, cy, col2w, 1.62, "192030");
  slide.addText("ECG: Peaked T → P-wave loss → Wide QRS → Sine wave → VF", {
    x: col2x + 0.1, y: cy + 0.6, w: col2w - 0.2, h: 0.5,
    fontSize: 9, color: C.lightGray, align: "center", fontFace: "Calibri",
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// COLUMN 3  (x=6.5, w=3.38)  — TREATMENT
// ═══════════════════════════════════════════════════════════════════════════════
const col3x = 6.5, col3w = 3.38;
cy = 1.26;

addPanel(slide, col3x, cy, col3w, 5.15, C.greenBg);
addSectionHeading(slide, "💊  EMERGENCY TREATMENT", col3x, cy, col3w, "145E3A");
cy += 0.28;

const treatments = [
  {
    step: "STEP 1",
    title: "Membrane Stabilization",
    color: C.red,
    items: [
      "IV Calcium Gluconate 10% — 10 mL over 2–3 min",
      "Onset <5 min, duration 30–60 min",
      "Repeat if ECG unchanged after 5 min",
      "Use Calcium Chloride (3× potency) in cardiac arrest",
    ],
  },
  {
    step: "STEP 2",
    title: "Shift K⁺ Intracellularly",
    color: "1A7A3A",
    items: [
      "Insulin 10 units IV + Dextrose 50% 50 mL",
      "↓ K⁺ by 0.6–1.0 mEq/L within 15–30 min",
      "Inhaled Salbutamol (Albuterol) 10–20 mg neb",
      "NaHCO₃ (if pH <7.2 & residual renal function)",
    ],
  },
  {
    step: "STEP 3",
    title: "Remove K⁺ from Body",
    color: "1A5C7A",
    items: [
      "Hemodialysis — most rapid & definitive method",
      "K⁺ binders: Patiromer, SZC (sodium zirconium)",
      "Loop diuretics (furosemide) — only if residual RFx",
      "Sodium polystyrene sulfonate (limited evidence)",
    ],
  },
];

let ty = cy + 0.06;
treatments.forEach(tx => {
  // step badge
  slide.addShape(pres.ShapeType.rect, {
    x: col3x + 0.12, y: ty, w: 0.55, h: 0.21,
    fill: { color: tx.color },
    line: { type: "none" },
  });
  slide.addText(tx.step, {
    x: col3x + 0.12, y: ty, w: 0.55, h: 0.21,
    fontSize: 7, bold: true, color: C.white, align: "center", valign: "middle",
    fontFace: "Calibri", margin: 0,
  });
  slide.addText(tx.title, {
    x: col3x + 0.72, y: ty, w: col3w - 0.84, h: 0.21,
    fontSize: 9.5, bold: true, color: C.amber, valign: "middle",
    fontFace: "Calibri",
  });
  ty += 0.24;

  tx.items.forEach(item => {
    slide.addText(item, {
      x: col3x + 0.22, y: ty, w: col3w - 0.34, h: 0.26,
      fontSize: 8, color: C.lightGray, fontFace: "Calibri", valign: "top",
      bullet: { code: "25B8", color: C.teal },
    });
    ty += 0.26;
  });
  ty += 0.1;
});

// Monitoring box
ty += 0.04;
slide.addShape(pres.ShapeType.rect, {
  x: col3x + 0.12, y: ty, w: col3w - 0.22, h: 0.6,
  fill: { color: "0D2818" },
  line: { color: C.amber, pt: 1 },
});
slide.addText([
  { text: "MONITORING: ", options: { bold: true, color: C.amber } },
  { text: "Continuous ECG  •  Serum K⁺ q1–2h  •  Blood glucose (insulin Rx)  •  Watch for hypoglycaemia", options: { color: C.lightGray } },
], {
  x: col3x + 0.18, y: ty + 0.06, w: col3w - 0.32, h: 0.48,
  fontSize: 7.5, fontFace: "Calibri", valign: "top",
});

// ── K⁺ THRESHOLD BAR ─────────────────────────────────────────────────────────
const barY = 7.08;
slide.addShape(pres.ShapeType.rect, {
  x: 0, y: barY, w: 10, h: 0.26,
  fill: { color: "0A1A28" },
  line: { type: "none" },
});
const thresholds = [
  { label: "Normal  3.5–5.0", x: 0.1, color: "2ECC71" },
  { label: "Mild  5.1–5.9", x: 2.1, color: C.amber },
  { label: "Moderate  6.0–6.5", x: 4.0, color: "E67E22" },
  { label: "Severe  >6.5  →  Emergent Tx", x: 6.1, color: C.red },
];
thresholds.forEach(t => {
  slide.addText(t.label, {
    x: t.x, y: barY + 0.01, w: 2.2, h: 0.24,
    fontSize: 8.5, bold: true, color: t.color, fontFace: "Calibri",
    align: "center", valign: "middle",
  });
});

// ── FOOTER ────────────────────────────────────────────────────────────────────
slide.addText("Sources: NKF Primer on Kidney Diseases 8e | Rosen's Emergency Medicine | Harrison's 21e | Brenner & Rector's The Kidney", {
  x: 0, y: 7.34, w: 10, h: 0.16,
  fontSize: 6, italic: true, color: C.midGray, align: "center",
  fontFace: "Calibri",
});

// ─── SAVE ────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/hyperkalemia-poster/Hyperkalemia_Dialysis_Poster.pptx" })
  .then(() => console.log("✅ Poster saved!"))
  .catch(err => console.error("❌ Error:", err));

Running Command

cd /home/daytona/workspace/hyperkalemia-poster && node create_poster.js

Running Command

ls -lh /home/daytona/workspace/hyperkalemia-poster/

Your poster is ready:

Hyperkalemia Dialysis Poster

Presentation · PPTX

What's on the poster

The single-slide clinical poster is organized into 3 columns on a dark navy background with a teal/amber/red color scheme:

Column 1 — Indications for Dialysis

K⁺ > 6.5 mEq/L, or K⁺ > 6.0 with ECG changes
AKI with hypercatabolism
Failure of medical therapy (insulin, calcium, binders)
Volume overload / uremic symptoms / acidosis
HD removes 25–50 mEq K⁺/session; dialysate K⁺ 0–2 mEq/L in severe cases
Fasting risk: >8–12 h fast → ↓ insulin → dangerous K⁺ shift — prevent with IV dextrose

Column 2 — Symptoms, Signs & ECG

Cardiac: palpitations, bradycardia, VF, arrest
Neuromuscular: weakness, paralysis, respiratory failure
GI: nausea, vomiting, ileus
Metabolic: Type IV RTA
Alert box: "Often clinically silent until life-threatening arrhythmia"
ECG progression table: Peaked T waves → ↓P waves → Wide QRS → Sine wave → VF
Harrison's ECG image embedded

Column 3 — Emergency Treatment (3-step protocol)

Step	Action
Step 1	IV Calcium Gluconate — membrane stabilization (onset <5 min)
Step 2	Insulin + Dextrose, Salbutamol nebuliser, NaHCO₃ — shift K⁺ into cells
Step 3	Hemodialysis (most rapid/definitive), patiromer/SZC binders, loop diuretics

Plus a K⁺ severity threshold bar at the bottom and monitoring reminders.

Sources: NKF Primer on Kidney Diseases 8e, Rosen's Emergency Medicine, Harrison's 21e, Brenner & Rector's The Kidney

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