⚡ Emergency Management of Hyperkalemia
This tool identifies a hyperkalemic emergency by potassium level and ECG changes and frames the three-step approach of membrane stabilization, intracellular shift, and potassium removal.
Emergency Management of Hyperkalemia
Serum potassium (mmol/L)
Hyperkalemic ECG changes (peaked T waves/loss of P waves/widened QRS, etc.)
Renal function
When to use
Use at the bedside to decide whether calcium, insulin/glucose, and removal therapy are needed and to choose dialysis versus binders by renal function.
How it works
Emergency = K ≥ 6.5 or hyperkalemic ECG changes. (1) Calcium gluconate stabilizes membrane; (2) insulin + glucose, salbutamol, ± bicarbonate shift; (3) loop diuretic/binders/dialysis remove (dialysis first-line in renal failure).
Key points
- IV calcium stabilizes the myocardium within minutes but does not lower potassium, so it is paired with shifting and removal therapies. (original synthesis · not guideline verbatim)
- Pseudohyperkalemia (hemolysis, tourniquet, extreme cell counts) is excluded before aggressive treatment.
- Potassium-raising drugs are stopped until K < 5.0 with serial rechecks.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.