Hyperkalaemia Electrolyte Disorders
Potassium Disorders
Hyperkalaemia
Overview
Hyperkalaemia is a common, potentially life‑threatening electrolyte disturbance seen frequently in emergency and acute care. Clinical severity ranges from an asymptomatic biochemical abnormality to progressive muscle weakness, flaccid paralysis and fatal cardiac arrhythmia.
Management priorities in the ED are rapid recognition, immediate cardioprotection when indicated, temporising measures to shift K+ intracellularly, definitive removal of K+ and treatment of the precipitant.
Continuous ECG monitoring and early nephrology/intensive‑care escalation are essential when there are ECG changes, haemodynamic instability, or failure of medical therapy.
When to act immediately (red flags)
- Any ECG change consistent with hyperkalaemia (peaked T waves, new QRS widening, new conduction block, sine‑wave appearance).
- Haemodynamic instability, severe muscle weakness with impending respiratory compromise, peri‑arrest or cardiac arrest.
- Very high potassium level by local protocol (commonly K ≥ 6.5 mmol/L, or K ≥ 6.0 mmol/L with symptoms or rapid rise). Treat the patient and ECG, not the number alone.
Clinical features
Most cases are oligosymptomatic. Typical findings: