Hyperkalemia is defined as a serum potassium level greater than 5.5 mmol/L. The severity can range from mild (<6.0 mmol/L) to moderate (6.0-7.0 mmol/L) to severe (7.0-8.0 mmol/L potentially causing ECG changes and above 8.0 mmol/L potentially causing cardiac arrest). Management involves stabilizing the membrane potential with calcium salts for ECG changes, shifting potassium into cells with insulin and glucose, removing potassium from the body with resins or dialysis, and preventing further increases by reviewing medications and diet.

1. Hyperkalemia
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2. Hyperkalemia:
• Serum potassium level >5.5 mmol/L

3. Severity of hyperkalemia
 Mild: K level <6.0 mmol/L maybe normal or show
only peaked T waves
 Moderate: K level 6.0 – 7.0 mmol/L (+) ECG may
show peaked T waves
 Severe:
• 7 – 8 mmol/L: (+)flattening of P waves & QRS
widening;
• 8 – 9 mmol/L: reveals fusion of QRS w/ T wave
that leads to AV dissociation, ventricular
dysrhythmias and death

4. Management of Hyperkalemia
Step 1: Stabilization of membrane potential
o Ca Chloride/ Ca Gluconate 10%: 10-20mL IV
over 3-10min
o Note: use only when there is ECG evidence of
hyperK, significant neuromuscular weakness
or serum K >7mmol/L

5. Step 2. shift ECF K into ICF
o Administer Dextrose/Insulin: 40-50 mL D50W
IV over 5-10 min & 10 units HR
o Administer Na Bicarbonate 1meq/Kg IV as
bolus over 5min in patient w/ moderate to
severe metabolic acidosis
Note: most useful in severely acidotic patient
o Salbutamol 5 mg + 3-4mL saline: nebulize over
10 min; use w/ caution in IHD

6. Step 3. Remove K from the body
o Resonium A: 15gms PO 4-6 hourly
o Hemodialysis
Step 4. Prevent further K increase
o Review al medications: Span K, ACEI,B
Blockers
o Dietary review and advice

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