Hyperkalaemia ⚡️

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🧠 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

🕒 20 / 11 / 2025 — 22:37

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: _______
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