🚑 EmergencyRenal / ElectrolyteStudentInternResident

Hyperkalaemia

Also known as: high potassium · raised K+ · electrolyte emergency

A high serum potassium — a potentially fatal emergency because of cardiac arrhythmia. Protect the heart, shift potassium into cells, then remove it.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Kidney disease/AKI, drugs (ACE inhibitors/ARBs, spironolactone, NSAIDs, trimethoprim), tissue breakdown (rhabdomyolysis, tumour lysis), acidosis and adrenal insufficiency.

Red flags — escalate / refer

ECG changes (peaked T waves, flattened P, widened QRS, sine wave) or K⁺ >6.5 mmol/L → emergency treatment now — risk of cardiac arrest.

Work-up / diagnosis

1Confirm the value (exclude a haemolysed/spurious sample) and get an URGENT ECG.
2Check renal function, glucose and acid-base; review drugs and the likely cause.

Management — overview

Protect the heart: IV calcium (gluconate or chloride) if there are ECG changes — it stabilises the myocardium but does NOT lower potassium.
Shift potassium into cells: IV insulin with dextrose, plus a salbutamol nebuliser.
Remove potassium: loop diuretics (if passing urine), potassium binders, and dialysis for severe/refractory cases or renal failure.
Stop potassium sources and offending drugs; treat the underlying cause.

In-depthFull dosing & advanced protocol

Drug dosing

Calcium gluconate 10%

Cardioprotection (ECG changes)

Adult dose: 10 mL IV over a few minutes; repeat if ECG changes persist
Route: Intravenous

Caution: Protects the heart but does not lower K⁺ — always follow with shifting + removal.

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Insulin (soluble) + dextrose

Shift potassium intracellularly

Adult dose: ~10 units soluble insulin with IV glucose; monitor blood glucose
Route: Intravenous

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Salbutamol nebuliser

Adjunct potassium shift

Adult dose: Nebulised (high dose)
Route: Inhaled

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

After the acute phase

Removal options: loop diuretics if making urine, oral/rectal potassium binders, and dialysis for refractory hyperkalaemia or established renal failure.
Recheck potassium and glucose after insulin-dextrose (watch for hypoglycaemia).
Chronic hyperkalaemia: dietary advice, review RAAS-inhibitors/potassium-sparing drugs, treat the cause.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

AnaphylaxisAcute, life-threatening systemic hypersensitivity with airway, breathing or circulation compromise within minutes of a trigger. Intramuscular adrenaline is the immediate, life-saving treatment.Snakebite EnvenomationA medical emergency from a venomous snakebite. In India the “Big Four” (cobra, krait, Russell's viper, saw-scaled viper) cause neurotoxic and/or haemotoxic envenomation. Polyvalent anti-snake venom (ASV) is the antidote; many bites are “dry”.Sepsis & Septic ShockLife-threatening organ dysfunction from a dysregulated host response to infection. Early recognition and the “hour-1 bundle” save lives; septic shock adds fluid-refractory hypotension.

Loading…

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Calcium gluconate 10%

Insulin (soluble) + dextrose

Salbutamol nebuliser

📈 After the acute phase

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Calcium gluconate 10%

Insulin (soluble) + dextrose

Salbutamol nebuliser

📈 After the acute phase

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

After the acute phase

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

After the acute phase

References