You should keep the following points in mind when treating patients in the Emergency Department:

Patient statistics

  • The majority of patients with disturbances of potassium balance are asymptomatic
  • The majority of patients with hyperkalaemia have some underlying renal dysfunction
  • Mortality as an inpatient is tenfold higher in hypokalemic patients. Careful monitoring and correction +/- supplementation must be achieved prior to discharge

Serum levels

  • Serum levels can be raised, normal or low in excess or deficiency of total body potassium
  • If a serum potassium level is raised in a well patient with normal renal function, take a repeat sample to check the first result was not spuriously elevated
  • Rapidly rising levels of serum potassium are more serious than slower rising levels


  • Remember medications are common causes of potassium disturbance
  • Potassium balance is intimately related to sodium, water, acid base balance and cannot be interpreted in isolation
  • ECG findings in hyperkalaemia are non-specific and the ECG is not a predictor of the presence or severity of hyperkalaemia
  • Remember to monitor glucose levels and administer glucose during treatment with insulin
  • Renal replacement therapy with haemofiltration or haemodialysis is the treatment of choice for life threatening hyperkalaemia refractory to medical management.
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