Hyperkalamia Management and Hyperkalamia Treatment Guidelines

Hyperkalamia Management and Hyperkalamia Treatment Guidelines


  • The normal potassium level in the blood is 3.5-5.0 milliequivalents per liter (mEq/L).

Hyperkalaemia is classified as a raised serum potassium level:

Mild: K+ – = 5.5 – 5.9mmol/L
Moderate: K+ = 6.0 – 6.4mmol/L
Severe: K+ ≥ 6.5mmol/L or if ECG changes or symptoms present



  • Hyperkalamia management is based on severity and first having to minimise its effect on cardiac muscles.
  • First if we suspect hyperkalamia (in patients of CKD, Burn, severe muscle disease, on ARB’s, NSAIDs, ACE inhibitors, Potassium sparing diuretics), we will first get an ECG done.
  • If we see hyperkalamia changes in ECG : We will first stablize myocardium.


  •  peaked T waves, loss of P waves, widening of QRS complexes, PR
    prolongation, asystole
Peaked T Waves


Disappearance of P waves
ECG showing Hyperkalamia

Treatment of Hyperkalamia

  • Stop all potassium supplements (IV and oral).
  • Review patient’s medication for possible contributors to hyperkalaemia and or
    acute renal failure.
  •  Reduce dietary K+intake.
  •  Ensure adequate hydration and urine output.
  •  If potassium > 6.5mmol/l or ECG changes monitor patients cardiac rhythm
    until it is stable and potassium level is in range.


1. STEP1

  • First we have to stablize myocardium by giving Calcium Gluconate or calcium chloride 
  • Onset of action is3-5 minutes (effect begins in minutes and is marked by improvement in ECG appearance.

2. STEP 2

  • Reduce serum K+ levels by shifting K+ from extracellular to intracellular fluid.
  • Drugs Given : 

A- Insulin ( glucose)Onset of action is within 15 minutes, it is fastest method.

B- Beta Agonists (Albuterol) In about 30 minutes

C- Sodium Bicarbonate –Onset of action is at least in 3-4 hours


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3. STEP 3

  • In this step we will remove excess potassium from body, by giving following:

A- Diuretics:Works only if patient has adequate kidney function.

B- Resin Exchangers (Keyexalate,sodium polystyrene sulfonate): slow acting requires 1-2 hors before K+ levels decrease.

Resin exchangers removes K+ from blood into gut in exchange for an equal amount of Na+

C- Hemodialysis:  Definitive treatment of choice in patients with advanced renal failure and severe hyperkalemia.


Hyperkalemia Management : According to Advanced Life support Guidelines

# Mild Elevation (5-5.5 meq/l)

Goal:- Remove Excess K+ from body

  • Cation exchange resins
  • Diuretics
  • consider dialysis

# Moderate/ Severe Elevation (without ECG changes) 

Goal:  Remove K+ from body

  • Dextrose/insulin infusion (+/-)
  • Nebulised salbutamol
  • Intravenous NaHCO3 (+)
  • cation Exchange resins
  • Diuretics
  • consider dialysis


# Moderate/Severe Elevation (with toxic ECG changes)

Goal: First stablize the heart/antagonize the toxic effects of hyperkalamia

  • Calcium gluconate
  • Dextrose/Insulin infusion (+)
  • Nebulise with Salbutamol
  • Intravenous NaHCO3 (+)
  • Cation exchange resins
  • Diuretics
  • consider dialysis





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