A fictional 69-year-old with acute kidney injury has a markedly raised potassium result and new broad-complex ECG changes.
Frame the danger first.
- Assess the potassium result alongside ECG findings, renal function, symptoms and rate of change.
- Exclude sampling artefact only when it is clinically safe to do so.
- Identify medicines, tissue injury, acidosis and impaired excretion that may be contributing.
Act, escalate, reassess.
- Escalate immediately and use the current UKKA/local hyperkalaemia protocol in a monitored setting.
- Protect the myocardium when indicated, then use protocol-directed measures to shift potassium intracellularly.
- Stop contributors where appropriate and decide how potassium will be removed from the body.
- Repeat potassium, glucose and ECG monitoring at protocol-defined intervals and plan for recurrence.
Red flags that change pace.
- ECG changes, arrhythmia, weakness or rapidly rising potassium
- Severe acute kidney injury, oliguria or treatment-resistant hyperkalaemia
- Need for urgent renal replacement therapy or critical-care monitoring
What makes care less safe.
- Delaying treatment for repeat sampling despite a convincing emergency
- Treating once without scheduled biochemical and glucose reassessment
- Forgetting that intracellular shift is temporary and does not remove potassium
Say the concern plainly.
Acute hyperkalaemia with potassium [result/trend], ECG [finding] and renal function [summary]. Immediate protocol measures are underway. I need urgent renal/critical-care input about definitive potassium removal and monitoring.