management of mild-moderate hyperkalaemia

Last edited 02/2018

Mild-moderate hyperkalaemia is plasma potassium in the range 5.5-6.4 mmol/l.

Identify the cause of hyperkalaemia and treat as appropriate.

The management of the hyperkalaemic patient involves:

  • ECG
    • all patients with a serum potassium value ≥ 6.0 mmol/L should have an urgent 12-lead ECG performed and assessed for changes of hyperkalaemia
  • treatment of hyperkalaemia
    • to shift pottasium into cells;
      • insulin-glucose (10 units soluble insulin in 25g glucose) by intravenous infusion may be used to treat moderate (potassium 6.0-6.4 mmol/L) hyperkalaemia
      • nebulised salbutamol 10-20mg may be used as adjuvant therapy for moderate (potassium 6.0-6.4 mmol/L) hyperkalaemia
    • remove potassium from body
      • loop diuretics (frusemide at a dose of 40 to 80 mg intravenously) is useful in removing potassium load from the system when renal function is preserved
      • cation exchange resins - calcium polystyrene sulfonate (CPS, K-bind powder) and sodium polystyrene sulfonate (SPS, kayexalate powder)
        • works in the GI tract, exchanging potassium for calcium (in CPS) and sodium (in SPS) respectively
  • address cause of hyperkalaemia and correct it
  • avoid potassium sparing or retaining drugs e.g. potassium sparing diuretics (e.g. frumil), beta-blockers, ACE inhibitors, NSAIDS, aspirin
  • a low potassium diet
  • haemodialysis: consider if oliguric; haemodialysis is more efficient than peritoneal dialysis at removing potassium (1,2,3)