Guideline summary · Renal · 6 min read
Acute hyperkalaemia in adults
Protect the heart, shift potassium into cells, then remove it.
Key points
- Severity: mild 5.5–5.9, moderate 6.0–6.4, severe 6.5 mmol/L or more.
- ECG changes: peaked T waves, flattened P waves, wide QRS, sine-wave pattern.
- IV calcium stabilises the myocardium within minutes but does not lower potassium.
- Insulin with glucose (and nebulised salbutamol) shifts potassium into cells.
- Remove potassium with binders, by stopping the cause, or by dialysis.
Summary based on the UK Kidney Association clinical practice guideline on acute hyperkalaemia in adults (2020). A study aid, not a substitute for the current guideline or local protocols.
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