Management Overview

The aims of management are to:

• Stabilise the myocardium
• Drive potassium into the cells
• Eliminate excess potassium from the body

Whilst doing all of this, we need to try to identify the underlying cause and treat this as well.

Fluid Resuscitation

In hyperkalaemic patients who require fluid resuscitation, there is often a debate about the best fluid to use. Clinicians are sometimes reluctant to use balanced crystalloids such as Hartmann’s solution (Ringer’s lactate) as these contain potassium.

However, a balanced crystalloid is preferable to 0.9% sodium chloride in these patients. Balanced crystalloids are more alkalinising and therefore would be expected to lead to a greater shift of potassium into cells. They have been shown to produce lower potassium levels in vivo compared with sodium chloride [6,7], and as they have less potassium per litre than the patient’s serum, they will actually lower the potassium level.

Medication Doses Caveat!

In the next few pages, doses given are acceptable standards with reference to evidence-based literature and the national formulary, however please ensure you consult your local guidelines when treating patients with hyperkalaemia.