If hyperkalaemia is indeed real and not caused by haemolysis or a bad sample, treatment can be appropriate. It’s urgent if there are ECG changes.

• Calcium gluconate
  • Stops membrane depolarisation
  • Does not reduce the serum potassium level
• Sodium bicarbonate IV
  • To treat metabolic acidosis, which can be a potential underlying cause
    • Potassium moves out of cells because it exchanges with hydrogen ions
• Insulin and glucose IV
  • Use short-acting insulin
  • To promote uptake of potassium into cells
  • Effective in kidney failure
• Polystyrene resin orally
  • Removes potassium from bowel lumen by exchanging it for sodium or calcium
  • Comes in sodium or calcium varieties, called Resonium
    • Sodium type adds to sodium load in body
    • Calcium type avoids this but is unsuitable in hypercalcaemia
• Dialysis
  • Last resort if extreme hyperkalaemia and nothing else works

Of course, the underlying cause should be treated; if it’s hypoaldosteronism, such as from adrenal insufficiency, corticosteroids should be given. If it’s volume depletion, that should be corrected. If the hyperkalaemia is caused by a medication, that medication should be ceased.

References

1. Electrolyte abnormalities. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited (eTG November 2017 edition); 2017 Nov.
2. acutecaretesting.org. (2013). On the relationship between potassium and acid-base balance. [online] Available at: https://acutecaretesting.org/en/journal-scans/on-the-relationship-between-potassium-and-acid-base-balance [Accessed 17 Feb. 2018].