Dr Swapnil Pawar April 4, 2021 934

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    Dr Swapnil Pawar

Written by – Dr Andrew Lam 


Causes of Hyperkalemia

Increased Intake

  • Excessive potassium dietary supplements
  • Excessive iatrogenic IV supplementation

Decreased Excretion

  • Acute or chronic renal failure/impairment
  • Hypoaldosteronism
  • Drugs (potassium sparing diuretics, ACEI’s, tacrolimus, cyclosporin)

Intercompartmental Shift

  • Pseudohyperkalemia (i.e. haemolysis from blood drawing) 
  • Acidosis
  • Insulin deficiency
  • Rapid Cell Lysis (i.e. rhabdomyolysis, cytotoxic therapy) 
  • Beta blockers

ECG changes in Hyperkalemia

Mild Changes (K > 5.5mmol/L)

  • Peaked T Waves

Moderate Changes (K > 6mmol/L)

  • P wave widening/flattening, followed by the disappearance
  • PR prolongation

Severe Changes (K > 7mmol/L)

  • Widened QRS interval
  • Sine-Wave Rhythm
  • Ultimately results in ventricular fibrillation or asystole

Management of Hyperkalemia

Hyperkalemic Emergency if any of the 3 criteria are met: 

  1. Clinical manifestations or ECG changes suggestive of hyperkalemia
  2. Serum potassium > 6.5s
  3. Serum potassium > 5.5 with renal impairment or ongoing tissue breakdown

In Hyperkalemic Emergency, immediate management requires:

  • Calcium Gluconate or Calcium Chloride (stabilises cardiac membrane) 
  • Insulin and glucose 
  • Bicarbonate (in patients who are concurrently acidotic)

This is given concurrently with therapy which removes potassium from the body:

  • Haemodialysis in patients with renal failure
  • Loop diuretics (i.e. frusemide)
  • Cation exchanger (i.e. resonium) 


Life in the Fast Lane. (2021). Hyperkalemia • LITFL • CCC. March 22, 2021, from,

Mount, D.B., (2020). Causes and evaluation of hyperkalaemia in adults. UpToDate. Retrieved March 22, 2021, from

Mount, D.B., (2020). Treatment and prevention of hyperkalaemia in adults. UpToDate. Retrieved March 22, 2021, from


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