Fast Five Quiz: Emergency Management of Hyperkalemia

A. Brent Alper, Jr, MD, MPH


March 23, 2022

Once the patient reaches the emergency department, initial management includes assessment of the airway, breathing, and circulation (ABC) and prompt evaluation of the patient's cardiac status with an ECG. Continuous ECG monitoring with frequent vital sign checks should be performed when hyperkalemia is suspected or when laboratory values are indicative of hyperkalemia.

Any potassium-sparing drugs or dietary potassium should be discontinued.

Dialysis is the definitive therapy in patients with renal failure or in whom pharmacologic therapy is insufficient. 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.

If the hyperkalemia is known to be severe (potassium > 7.0 mEq/L) or if the patient is symptomatic, treatment should be started before diagnostic investigation of the underlying cause and individualized based upon the patient's presentation, potassium level, and ECG.

Learn more about the management of hyperkalemia.


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