Hyperkalaemia: causes,electrocardiographic changes and management

Abstract

Hyperkalaemia is an ever present threat in dialysis units and is encountered frequently on general wards, particularly in patients with renal failure. It is important because it can cause life threatening cardiac dysrhythmia, with death by asystole or ventricular fibrillation commonly the first clinical manifestation. I Preferred therapy varies, reflecting the lack of clear evidence for an optimal regimen, but broadly speaking the choice of treatment is based upon the serum potassium level, the ECG and the likelihood that potassium will rise further. In this review we highlight the causes, sequelae and evidence for the treatment of hyperkalaemia. Our starting point is a serum potassium of 6 mmol/l. Thereafter, we suggest it may be useful to distinguish two groups of patients on the basis of their ECG: those whose ECG is normal, whom we consider to have severe hyperkalaemia, and those with ECG evidence of raised serum potassium or life threatening hyperkalaemia.