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Acute Hyperkalemia Management - Hospitalist

Acute Hyperkalemia Management - Hospitalist: Hyperkalemia Detected → Confirm True Hyperkalemia → Get STAT ECG → Severity Assessment → SEVERE: Emergency ...

Pathway Overview

10 steps

Algorithm Steps

10 total

  1. 01Start

    Hyperkalemia Detected

    K+ >5.5 mEq/L

  2. 02Action

    Confirm True Hyperkalemia

    Rule out pseudohyperkalemia

    • PSEUDOHYPERKALEMIA causes:
    • - Hemolyzed sample
    • - Prolonged tourniquet
    • - Fist clenching
    • - Thrombocytosis/leukocytosis
    • IF DOUBT: Repeat stat, no tourniquet
    • Check for consistency with clinical picture
  3. 03Warning

    Get STAT ECG

    Assess cardiac toxicity

    • ECG CHANGES (progressive):
    • 1. Peaked T waves (earliest)
    • 2. PR prolongation
    • 3. QRS widening
    • 4. Loss of P waves
    • 5. Sine wave pattern
    • 6. VF/asystole
    • ANY ECG CHANGES = EMERGENCY
  4. 04Decision

    Severity Assessment

    Determines urgency

    • MILD: K+ 5.5-6.0
    • MODERATE: K+ 6.0-6.5
    • SEVERE: K+ >6.5 OR ANY ECG changes
  5. 05Warning

    SEVERE: Emergency Treatment

    K+ >6.5 or ECG changes

    • 1. CALCIUM GLUCONATE 10%:
    • - 1-2 grams (10-20 mL) IV over 2-3 min
    • - Cardiac membrane stabilization
    • - Effect immediate, lasts 30-60 min
    • - Can repeat in 5 min if needed
    • 2. SHIFT K+ INTRACELLULAR (see next)
    • 3. REMOVE K+ from body
    • 4. CARDIOLOGY/NEPHROLOGY stat
  6. 06Action

    Shift K+ Intracellularly

    Temporary measures

    • INSULIN + DEXTROSE:
    • - Regular insulin 10 units IV
    • - D50 25g (50 mL) IV push
    • - Onset 15-30 min, lasts 4-6 hrs
    • - Monitor glucose closely
    • ALBUTEROL:
    • - 10-20 mg nebulized
    • - Onset 30 min
    • - Avoid if tachyarrhythmia
    • SODIUM BICARBONATE:
    • - Only if metabolic acidosis
    • - 50-100 mEq IV
    • - Less effective alone
  7. 07Action

    Remove K+ from Body

    Definitive treatment

    • DIURETICS (if kidney function):
    • - Furosemide 40-80 mg IV
    • - Increases urinary K+ excretion
    • GI BINDERS:
    • - Patiromer (Veltassa) 8.4g PO
    • - SZC (Lokelma) 10g PO x 3
    • - Onset 1-6 hours
    • - Kayexalate: Less preferred (GI issues)
    • DIALYSIS:
    • - Most effective for severe/refractory
    • - Removes 25-50 mEq/hr
  8. 08Action

    Monitoring

    Reassess frequently

    • SEVERE: Check K+ q1-2h
    • MODERATE: Check K+ q4-6h
    • MILD: Check K+ q6-12h
    • Repeat ECG if worsening
    • Monitor glucose after insulin
    • Watch for rebound hyperkalemia
  9. 09Outcome

    Outcomes

    Goals

    • Target K+ <5.5 mEq/L
    • Resolution of ECG changes
    • Address underlying cause
    • Long-term management plan
    • Education on K+ restriction
  10. 10Action

    Mild-Moderate: Address Causes

    K+ 5.5-6.5, no ECG changes

    • STOP K+ intake:
    • - Hold K+ supplements
    • - Low K+ diet
    • REVIEW MEDICATIONS:
    • - ACEi/ARB
    • - K+-sparing diuretics
    • - NSAIDs
    • - Trimethoprim
    • - Beta-blockers
    • TREAT UNDERLYING:
    • - AKI, metabolic acidosis
    • - Adrenal insufficiency
  11. Path rejoins step 08Shared downstream outcome

Guideline Source

AHA/KDIGO Hyperkalemia Management Consensus

DOI: N/A

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Pseudohyperkalemia must be excluded
  • ECG changes may lag behind K+ level
  • Dialysis access required for severe cases
  • Kayexalate onset delayed

Applicable Regions

USEU
Version 1Next review: 2027-01-11

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Frequently Asked Questions

What is the Acute Hyperkalemia Management - Hospitalist?

The Acute Hyperkalemia Management - Hospitalist is a emergency clinical algorithm for Internal Medicine. It provides a structured decision tree to guide clinical decision-making, based on AHA/KDIGO Hyperkalemia Management Consensus.

What guideline is the Acute Hyperkalemia Management - Hospitalist based on?

This algorithm is based on AHA/KDIGO Hyperkalemia Management Consensus (DOI: N/A).

What are the limitations of the Acute Hyperkalemia Management - Hospitalist?

Known limitations include: Pseudohyperkalemia must be excluded; ECG changes may lag behind K+ level; Dialysis access required for severe cases; Kayexalate onset delayed. Individual patient factors may require deviation from these recommendations.

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