Hyperkalemia - NYSORA

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Learning objectives

  • Definition, diagnosis, and management of hyperkalemia


  • Hyperkalemia is an elevated level of potassium (K+) in the blood:
    • Mild: a serum K+ 5.5 – 5.9 mmol/L
    • Moderate: a serum K+6.0-6.4 mmol/L
    • Severe: a serum K+  ≥ 6.5  mmol/L

Signs and symptoms

  • Gastro-intestinal
    • Nausea
    • Vomiting
    • Diarrhea
  • Neuromuscular 
    • Paresthesias
    • Muscle fasciculations
    • Ascending paralysis of the extremities (quadriplegia)
  • Cardiac
    • Dyspnea
    • Progressive ECG changes with increasing severity of hyperkalemia
      • Peaked T wave
      • Wide PR interval
      • Wide QRS duration
      • Loss of P wave
      • Sinusoidal wave


Renal failure
MedicationsAngiotensin-converting enzyme inhibitors (ACE-i)
Angiotensin II receptor blockers (ARB)
Potassium-sparing diuretics
Non-steroidal anti-inflammatory drugs (NSAIDs)
Trimethoprim (antibiotic)
Tissue breakdownRhabdomyolysis
Endocrine disorders Diabetes mellitus type 2
Adrenocortical insufficiency


  • First, ensure that the lab result is correct and rule out pseudohyperkalemia
  • Typical examples:
    • Poor storage of blood specimens
    • Long transport time from blood draw of the sample to processing in the lab

Hyperkalemia, K+, peaked T waves, broad QRS, sine wave, bradycardia, VT, calcium chloride, calcium gluconate, insulin, glucose, salbutamol, sodium zirconium cyclosilicate, patiromer, calcium resonium, dialysis

Suggested reading

  • Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances [published correction appears in Resuscitation. 2021 Oct;167:91-92]. Resuscitation. 2021;161:152-219.
  • Palmer BF, Carrero JJ, Clegg DJ, et al. Clinical Management of Hyperkalemia. Mayo Clin Proc. 2021;96(3):744-762.
  • Palmer BF, Clegg DJ. Diagnosis and treatment of hyperkalemia. Cleve Clin J Med. 2017;84(12):934-942. doi:10.3949/ccjm.84a.17056

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