Hyperkalemia in Emergency Medicine Treatment & Management

  • Author: David Garth, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Apr 25, 2012
 

Prehospital Care

A patient with known hyperkalemia or a patient with renal failure with suspected hyperkalemia should have intravenous access established and should be placed on a cardiac monitor.[8] In the presence of hypotension or marked QRS widening, intravenous bicarbonate, calcium, and insulin given together with 50% dextrose may be appropriate as discussed in Medication. Avoid calcium if digoxin toxicity is suspected. Magnesium sulfate (2 g over 5 min) may be used alternatively in the face of digoxin-toxic cardiac arrhythmias.

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Emergency Department Care

Perform continuous ECG monitoring with frequent vital sign checks when hyperkalemia is suspected or when laboratory values indicative of hyperkalemia are received.

Initial management includes assessment of the ABCs and prompt evaluation of the patient's cardiac status with an ECG.

Discontinue any potassium-sparing drugs or dietary potassium.

If the hyperkalemia is severe (potassium >7.0 mEq/L) or if the patient is symptomatic, begin treatment before diagnostic investigation of the underlying cause. Individualize treatment based upon the patient's presentation, potassium level, and ECG. Not all patients should receive every medication listed in Medication s. Patients with mild hyperkalemia, for example, may need only excretion enhancement.

Some studies are emerging that suggest sodium polystyrene sulfonate (SPS), also known as Kayexalate, may be unhelpful in hyperkalemia and may increase the chance of colonic necrosis (especially when used with sorbitol).[9, 10, 11, 12]

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Consultations

Consult a nephrologist or the dialysis team for patients with either severe symptomatic hyperkalemia or renal failure. Admit these patients to an ICU.

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Contributor Information and Disclosures
Author

David Garth, MD  Attending Physician, Department of Emergency Medicine, Mary Washington Hospital

David Garth, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard A Bessen, MD  Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

I would like to thank my wife Mary, and my children, for allowing me the time away from them to keep on researching.

References

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Peaked T waves in hyperkalemia.
Peaked T waves in hyperkalemia.
Widened QRS complexes in hyperkalemia.
Widened QRS complexes in a patient whose serum potassium level was 7.8 mEq/L.
ECG of a patient with pretreatment potassium level of 7.8 mEq/L and widened QRS complexes after receiving 1 ampule of calcium chloride. Notice narrowing of QRS complexes and reduction of T waves.
 
 
 
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