💡Hyperkalemia Management — Evidence-Based Approach
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1️⃣ Confirm True Hyperkalemia
➊ K⁺ >5.5 mmol/L = hyperkalemia
➋ Exclude pseudohyperkalemia from hemolysis
➌ Check renal function, medications, acid–base status
➍ Obtain urgent ECG if K⁺ is high or patient is unwell
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2️⃣ ECG Changes to Recognize
➊ Peaked T waves
➋ PR prolongation
➌ Flattened/absent P waves
➍ QRS widening
➎ Sine-wave pattern = pre-arrest emergency
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3️⃣ Protect the Heart First
➊ IV calcium gluconate or calcium chloride
➋ Stabilizes cardiac membrane within minutes
➌ Does NOT reduce serum potassium
Use immediately if ECG changes or severe hyperkalemia.
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4️⃣ Shift K⁺ Into Cells
➊ Insulin + glucose
➋ Nebulized salbutamol
➌ Sodium bicarbonate if significant metabolic acidosis
These act quickly but temporarily, so potassium removal is still required.
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5️⃣ Remove K⁺ From the Body
➊ Loop diuretics if producing urine
➋ Potassium binders
➌ Hemodialysis for refractory, severe, or ESRD-related hyperkalemia
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6️⃣ Treat the Cause
Common triggers include:
• AKI / CKD
• ACE inhibitors / ARBs
• Spironolactone
• Potassium supplements
• Metabolic acidosis
• Tissue breakdown
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