Hyperkalaemia Management Algorithm
Grades acute hyperkalaemia by serum potassium and ECG changes, with the treatment steps of the UK Kidney Association 2020 adult guideline (protect the heart, shift potassium into cells, remove potassium).
Score interpretation
Serum K⁺ below 5.5 mmol/L and no ECG changes.
→ No hyperkalaemia treatment needed.
UKKA mild hyperkalaemia, no ECG changes.
→ Treat the cause; review contributing drugs (ACE inhibitor, ARB, MRA, NSAID, trimethoprim, potassium supplements) and diet; repeat K⁺.
UKKA moderate hyperkalaemia, no ECG changes.
→ 12-lead ECG and monitoring; repeat K⁺; treat the cause. Adults: UKKA suggests insulin–glucose (10 units soluble insulin in 25 g glucose IV) and nebulised salbutamol 10–20 mg as an adjunct; monitor blood glucose. Children: use a children's formulary.
UKKA severe hyperkalaemia, no ECG changes.
→ Emergency: continuous cardiac monitoring; senior and renal review — dialysis if refractory. Adults: insulin–glucose (10 units soluble insulin in 25 g glucose IV; then 10% glucose 50 mL/h for 5 h if pre-treatment glucose < 7.0 mmol/L) plus nebulised salbutamol 10–20 mg (not salbutamol alone); consider sodium zirconium cyclosilicate 10 g three times daily. Children: use a children's formulary.
ECG changes of hyperkalaemia (peaked T waves, flattened P waves, wide QRS, sine wave, arrhythmia or arrest).
→ Protect the myocardium with IV calcium, then shift and remove potassium as for severe hyperkalaemia; continuous ECG monitoring; senior / critical care review. Adults: calcium chloride or calcium gluconate 6.8 mmol IV. Children: use a children's formulary. Cardiac arrest: follow the ALS hyperkalaemia algorithm.
Interpretation bands for the Hyperkalaemia Management. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Calcium Gluconate · Electrolyte — Calcium Supplement
- Calcium Gluconate 10% · Electrolyte
- Potassium Chloride (IV) · Electrolyte — Potassium Supplement
- Insulin (IV Infusion — ICU Glucose Control) · Insulin — ICU Glucose Management
- Sodium Chloride 3% (Hypertonic Saline) · Hypertonic Electrolyte Solution — ICP/Hyponatraemia Management
- Potassium chloride with calcium chloride and sodium chloride · Crystalloid IV fluid
- Falls Assessment in Older Adults · NICE CG161 2013
- Anaemia Investigation · BSH / NICE
- Lower Respiratory Tract Infection (Primary Care) · NICE NG138 / NICE antimicrobial guidance
- Hypertension Management · NICE NG136 2019
- Hyperkalaemia Management · UK Kidney Association Guidelines 2020; NICE CKD Guidelines
- Rhabdomyolysis · Renal Association 2018; UpToDate 2024
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.