Introduction
Hyperkalaemia is a frequent issue identified in hospitalised patients, affecting 1-10%. It is important to understand the causes, assessment and treatment as hyperkalaemia can lead to life-threatening cardiac arrhythmias, cardiac arrest and respiratory depression. Hyperkalaemia is a medical emergency.
It is vital that the Junior Doctor has a good framework for approaching the various causes of hyperkalaemia, can determine severity and understands the different tiers of treatment depending on the severity of the hyperkalaemia.
Content Contributors:
Author: Dr Elisabeth O’Brien
CONTENT APPROVAL: Dr Christian Farrugia
EDITOR: Dr Sahani Jayawardane
Version History Version
Version 1 – July 2021
It requires 20 minute preparation.
It can be taught in 1 hour
Teaching approach
As with all modules, familiarise yourself with the NPMT principles.
session learning objectives:
Students must identify hyperkalaemia as a medical emergency and develop a framework for analysing the various causes
To understand the assessment of hyperkalaemia including primary survey, history, exam and investigations
To understand the treatment of hyperkalaemia based on the severity of the hyperkalaemia identified
Tips & Tricks on running an effective session:
Students should consider the large differences between intracellular (155mmol) and extracellular (3.5-5mmoll) Potassium to understand the importance of this electrolyte in cardiac and skeletal muscle function
It should be emphasised that if a patient is symptomatic or has signs of hyperkalaemia (eg ECG changes) this should be managed as severe hyperkalaemia and treated immediately.
it should be emphasised to students that if potassium rises slowly, often signs and symptoms do not develop until levels are >7.0mmol/L. If the change is more acute, these signs and symptoms can develop rapidly.
Students should be prompted to develop a framework to break down the various causes of hyperkalaemia. Consider going around the room, asking each student to volunteer a cause.
Students should be aware that some diuretics can cause hyperkalemia (spironolactone) and others are used to treat it! (frusemide).
It should be emphasised to students that a patient’s serum potassium should not be the only indicator for management. Urgent treatment is indicated if Potassium level >7.0 OR >5.5 with ECG changes or symptoms.
Students should have a go at using the fluid chart to show how they would chart fluid and dextrose solution for severe hyperkalaemia