How to treat hyperkalaemia?

My thought process and how I remember the management plan

Possible scenarios:

1. You have just diagnosed someone with hyperkalaemia

2. Your consultant/reg is drilling you on hyperkalaemia management

How do you manage hyperkalaemia?

I’m not going to cover the symptoms and signs and investigations, you can read that up here:

My thought process:

1. PROTECT the heart

2. MOVE potassium away from the extracellular space and into the cells

3. REMOVE potassium from the body

4. STOP more potassium accumulation in the blood

REMEMBER YOUR A TO E ASSESSMENT!

Patient may need Oxygen etc! Check the potassium levels when you do the ABG (it’s faster than waiting for U&E’s)

PROTECT THE HEART:

High level of potassium will affect the heart. It can lead to arrhythmias for example. So you want to protect the heart as your FIRST step and this is done by giving a membrane stabilising drug:

• 10 mL of 10% IV Calcium gluconate STAT over 2 minutes (can be repeated every 15 minutes: MAX dose of 50 mL - so 5 doses)

  • This does NOT lower potassium levels. It just provides heart protection

MOVE

You now need to move the K+ away from the extracellular space and into the cells where they are less harmful to you. You can do this in 2 ways, by giving 2 substances:

• 5 mg Salbutamol Nebs

• 10 unit Actrapid infusion in 50 mL of 50% glucose given over 10 minutes - Insulin/glucose infusion

• The K+ being in the extracellular is the main problem. We need to MOVE it into the cells. Both salbutamol and insulin/dextrose play a role in doing this. Sodium Potassium pumps etc bla bla all that jazz from physiology.

REMOVE

You next want to REMOVE K+ from the body and this can be done by giving:

• Calcium resonium (oral or enema)

  • Enema more effective

• Loop diuretics

• Dialysis for patients with AKI with persistent hyperkalaemia

STOP

• Stop any fluids containing potassium

• Stop any drugs that increase potassium levels such as, but not limited to:

  • Potassium-sparing diuretics - Spironolactone

  • ACE inhibitors

This is a quick and easy way to remember the management for hyperkalaemia, I hope it helps you :)

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