Emergency MedicineRenal
Hyperkalaemia Management
Risk stratification and urgent treatment of hyperkalaemia with cardiac stabilisation, potassium shifting, and elimination strategies.
Source: UK Kidney Association Guidelines 2020; NICE CKD Guidelines
Used in: Hyperkalaemia
Step 1 of ~9
action
Confirm and Classify Severity
Confirm hyperkalaemia (exclude pseudo-hyperkalaemia: haemolysis, delayed processing, EDTA contamination — repeat from fresh sample if doubt).
Severity:
• Mild: K+ 5.5–5.9 mmol/L
• Moderate: K+ 6.0–6.4 mmol/L
• Severe: K+ ≥6.5 mmol/L or any with ECG changes
Obtain immediate 12-lead ECG.
Blood: U&E (repeat), ABG (acidosis compounds hyperkalaemia), FBC, blood glucose.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Amiloride hydrochloride · Potassium-sparing diuretic (epithelial Na+ channel blocker)
- Furosemide with triamterene · Loop diuretic + potassium-sparing
- Nicorandil · Potassium channel activator with nitrate component
- Amiloride with Bumetanide · Potassium-Sparing Diuretic + Loop Diuretic (Fixed-Dose Combination)
- Potassium chloride with calcium chloride and sodium chloride · Crystalloid IV fluid
- Potassium chloride with calcium chloride sodium chloride and sodium lactate · Balanced crystalloid IV fluid
Pathways
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
A deeper exam-focused version of this pathway is available on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only. Always apply local guidelines and clinical judgement.