Home > Adults > Biochemistry >

Hyperkalaemia

Checked: 23-07-2022 by Rob Adams Next Review: 23-07-2023

Overview

Hyperkalaemia is a potentially life-threatening emergency which can be corrected with treatment (1)

Potassium is essential for the body’s normal function, including maintenance of normal heart rhythm. The way the body responds to hyperkalaemia is unpredictable; arrhythmias and cardiac arrest can occur without warning. Hyperkalaemia can affect patients in hospital and in the community.

In 2018 a CAS alert highlighted the risk of cardiac arrrest in patients with hyperkalaemia and advised organisations to put in place processes to ensure early identification and appropriate follow up of patients:

(1) Patient Safety Alert - Resources to support safe management of hyperkalaemia (2018)

Management in primary care

Hyperkalaemia can have several different causes and management depends on the clinical scenario as well as the serum level of potassium.

For patients with stable heart failure and hyperkalaemia - please see the Cardiovascular System Guideline page of the formulary and scroll down to the Heart Failure section to the document: Traffic light: How to monitor renal function and potassium rises in stable Heart Failure

For patients under the renal physicians - patients should be monitored and managed by the renal team, but if you have concerns then please contact the on call renal team for advice via NBT switch (0117 9505050). See also the red flag section of the Chronic Kidney Disease page.

For patients with acute kidney injury - please see the Acute Kidney Injury page.

For all other patients with hyperkalaemia - there are guidelines on managing hyperkalaemia produced by NBT available on their webpage: Clincal Biochemistry in primary care.

If you wish to discuss further with the duty biochemist for your local hospital then please see the contact details on the Clinical Biochemistry page.

Red Flags

There is a risk of cardiotoxicity and sudden death with severe hyperkalemia or those with ECG changes.

Urgent referral to secondary care via a medical admission is therefore recommended for patients with:

K ≥6.5mmol/L
Acute ECG changes* and K ≥5.5mmol/L
Acute increase in K >0.5mmol/L in 6-12 hours

*All those with K ≥6.0mmol/L should have an ECG. ECG may show bradycardia, P waves absent or PR prolongation, peaked T waves, widened QRS, VT or VF. (2)

(2) Hyperkalaemia (nbt.nhs.uk)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.