Hyperkalaemia ⚡️
Emergency management of hyperkalaemia. ECG changes, treatment protocol, calcium gluconate, insulin-dextrose, and hyperkalaemia calculator for on-call doctors.
🧠 Definition & Causes
- Plasma K⁺ > 5.5 mmol/L (Normal range: 3.5–5.1)
- Can lead to dangerous arrhythmias — requires prompt treatment
- Common in AKI/CKD, medications affecting RAAS, poor glycaemic control
- Drugs: ACEi, ARBs, spironolactone, amiloride, beta-blockers, NSAIDs, trimethoprim, potassium supplements
📋 Key Steps in Management
- 1. Confirm diagnosis — venous sample + ECG
- 2. Cardiac membrane stabilization (Ca²⁺)
- 3. Shift K⁺ intracellularly (insulin/glucose, salbutamol)
- 4. Enhance K⁺ elimination (Resonium, loop diuretics)
- 5. Identify and treat underlying cause
⚠️ When to Monitor Closely
- K⁺ ≥ 6.5 mmol/L
- ECG features of hyperkalaemia
- K⁺ 6.0–6.4 mmol/L with clinical deterioration
- In these cases, use continuous ECG/telemetry if available
🩺 ECG & Blood Monitoring
- Do 12-lead ECG if K⁺ ≥ 5.5 mmol/L
- Continuous ECG if severe or symptomatic
- Monitor glucose with insulin therapy to avoid hypoglycaemia
- Target glucose: 5–7 mmol/L
💊 First-Line Treatment Steps
- If K⁺ ≥ 6 OR ECG changes:
- Calcium gluconate 10% 30ml IV over 15 min via large vein or central line
- Give over 30 mins if on digoxin. Avoid in hypercalcaemia (adjusted Ca²⁺ ≥ 3)
- May repeat after 5 min if ECG changes persist
- Do not mix with other drugs
💉 Shift Potassium Intracellularly
- 10 units Actrapid® + 50ml glucose 50% IV over 15 min
- Skip glucose if pre-treatment glucose >15 mmol/L
- Add 10% glucose @ 50ml/hr for 5h if glucose <7
- Nebulised salbutamol 10mg — caution in tachycardia/if on beta-blockers
🚽 Enhance Elimination
- Stop K⁺-retaining meds and infusions
- Consider calcium resonium 15g TDS PO + lactulose
- Avoid in bowel obstruction/stoma/hypercalcaemia
- Consider furosemide 40mg IV if euvolaemic
- Volume resuscitate as needed
🧪 Acidosis Correction
- If metabolic acidosis present:
- Use 1.26% sodium bicarbonate IV (via glucose 5%)
- Do NOT use with 0.9% NaCl — risk of hypertonicity
- 8.4% sodium bicarb IV only in critical care with central line
📈 Monitoring Timetable
- Monitor K⁺ & Glucose at 0, 15, 30, 60, 90 min, then 2, 3, 4, 5, 6, 8, 10, 12, 24h
- If K⁺ <5.5 at 4h, next K⁺ check can be at 12h
- Treat hypoglycaemia if glucose <4 mmol/L
⚠️ When to Refer
- K⁺ remains >6.5 after treatment
- ESRD or dialysis patients
- Oliguric/anuric AKI
- ECG changes persist despite therapy
Hyperkalaemia Management Assistant
Emergency management guidance for elevated potassium
Clinical Factors
Note Template
Ready-to-use clinical note structure
🕒 26 / 05 / 2026 — 12:26 ATRP re: hyperkalaemia Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [CKD / diabetes / medications affecting K⁺] 🧾 Hx: • Symptoms: [weakness / palpitations / chest discomfort] • Duration: [acute / chronic] • Medications: [ACEi / ARB / spironolactone / others] • Diet / supplements 🩺 Exam: • HR: __ BP: __ RR: __ Temp: __ SpO₂: __ • Signs of arrhythmia or volume overload • Neuro: [alert / confused] 📋 Impression: Likely cause: [renal impairment / medications / acidosis] 📌 Plan: • Venous K⁺ and ECG • Management and review cadence as per management plan / local hyperkalaemia protocol 👤 [Your Name], [Role] IMC: _______