Emergency Management of Hyperkalaemia in Adults

 Assess patient using ABCDE approach Date: ___/___/___ Time ___:____

 12-lead ECG and monitor cardiac rhythm if serum K+ ≥ 6.0 mmol/l
 Exclude pseudohyperkalaemia First 15-30 minutes
 Give empirical treatment for arrhythmia if hyperkalaemia suspected

Na+: ______ pH ___.___

MILD MODERATE K+: ____.__ pCO2 ___.__

+
SEVERE !
+
K 5.5 - 5.9 mmol/L K 6.0 - 6.4 mmol/L +
Treatment guided by clinical
K ≥ 6.5 mmol/L Urea: ____.__ pO2: ____.__
Consider cause and need Emergency treatment indicated
for treatment condition, ECG and rate of rise Creat: ______ Bicarb :
_____
Seek expert help Time: ___:___
Use ABG machine to BE:
monitor K+
_______

ECG Changes?
Peaked T waves Broad QRS Bradycarcia
IV Calcium (6.8 mmol)
Flat/ absent P waves Sine wave VT
10 ml 10% Calcium Chloride IV OR
NO YES
30 ml 10% Calcium Gluconate IV
Use large IV access and give over 5 min
Protect the Calcium Chloride OR
Heart Calcium Gluconate IV Repeat ECG
(6.8 mmol) Consider further dose after 5 min if
ECG changes

Insulin–Glucose IV Infusion Next 30-60 minutes

Shift K+
into cells Give 10 units soluble insulin in 25 g glucose
Give 10% glucose @ 50ml/hr for 5 hrs (25g) if GLUCOSE REGIMEN (25g glucose)
pre-treatment blood glucose < 7.0mmol/l = 50ml 50% glucose

Risk of hypoglycaemia = 125ml 20% glucose

Consider
= 250ml 10% glucose
Salbutamol 10 – 20 mg Nebulised

Life-threatening
Consider
hyperkalaemia
Blood Monitoring:
Remove K+ Calcium resonium Sodium zirconium cyclosilicate
15g tds orally OR 10g tds for 72 hrs Glucose K+
from body OR
30g bd per rectum Baseline ___.___ ___.___
Patiromer
8.4g once daily 30 min ___.___
60 min ___.___ ___.___
Consider Dialysis 90 min ___.___
Seek expert help ! 120 min ___.___ ___.___
180 min ___.___
240 min ___.___ ___.___
Monitor K+
Monitor serum K+ and blood glucose 300 min ___.___
and Glucose K+ ≥ 6.5 mmol/l despite 360 min ___.___ ___.___
medical therapy
480 min ___.___
Prevention Consider cause and prevent further rise or recurrence 720 min ___.___ ___.___

K+: potassium; Na+: sodium; Creat: creatinine; Bicarb: bicarbonate; BM: blood glucose; max - maximum

Publication Date: 1.7.2020 Review Date: 1.7.2025 The Renal Association UK