Raised potassium

Hyperkalaemia is an increase in the level of potassium in the blood. There is no universally accepted definition of hyperkalaemia, however, guidelines have adopted a threshold serum potassium (K+ ) level of ≥ 5.5 mmol/L (1)

• it can be divided into (1)
  • mild - 5.5–5.9 mmol/L
  • moderate - 6.0–6.4 mmol/L
  • severe - ≥6.5 mmol/L (1)
• in addition to the absolute serum K + value, the rate of rise of serum K + is also important

Co-existing metabolic disturbances may ameliorate (e.g. hypernatraemia, hypercalcaemia, and alkalaemia) or exacerbate (e.g. hyponatraemia, hypocalcaemia or acidosis) the effects of hyperkalaemia (2).

Repetitive consecutive measures of serum potassium are needed to determine if hyperkalaemia is sustained or a transient event (2).

• evaluation of serum potassium must take into consideration the effects of changes in serum pH
  • if serum pH decreases (acidaemia), serum potassium increases because potassium shifts from the cellular to the vascular space
  • if serum pH increases (alkalaemia), serum potassium decreases because potassium shifts intracellularly

The condition is seen in 1-10% of hospitalised patients (1)

Hyperkalaemia may be fatal as a result of arrhythmias and cardiac arrest (2).

Reference:

(1) UK Kidney Association. Clinical Practice Guidelines - Management of Hyperkalaemia in Adults. October 2023.

(2) Lott C et. al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021 Apr;161:152-219. doi: 10.1016/j.resuscitation.2021.02.011.