Further Outpatient Care

Adjust diet to decrease potassium dietary load.

Adjust medications that predispose to or exacerbate hyperkalemia.

Repeat potassium level tests in 2-3 days.

Reevaluate renal function if signs of renal insufficiency are present.

Further Inpatient Care

Order continuous cardiac monitoring for patients who are hyperkalemic.

Definitive therapy is dialysis in patients with renal failure or when pharmacologic therapy is not sufficient. Any patient with significantly elevated potassium levels should undergo dialysis, as pharmacologic therapy alone is not likely to adequately bring down the potassium levels in a timely fashion.

Monitor serial potassium levels.

Resolve acid-base problems.

Correct coexistent electrolyte disturbances.

Treat digoxin toxicity, if present.

Transfer

If unable to correct hyperkalemia with pharmacologic therapy and dialysis is unavailable, stabilize the patient and transfer to a center where dialysis can be performed.

Deterrence/Prevention

Avoid foods high in potassium.

Avoid medications that predispose to hyperkalemia.

Complications

Life-threatening cardiac arrhythmias may ensue.

Hypokalemia may result from the treatment of hyperkalemia.

Prognosis

Expect full resolution with correction of the underlying etiology.

Reduction of plasma potassium should begin within the first hour of initiation of treatment.

Patient Education

Pursue diet modification.

Discontinue use of medications that may worsen hyperkalemia.

Encourage adherence to dialysis schedule if patient is noncompliant.

Questions

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Media Gallery

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.