Introduction

• Normal range of serum potassium: 3.5 – 5.1 mmol/L
• Severity of hyperkalaemia:
  • Mild: 5.5 – 5.9 mmol/L
  • Moderate: 6 – 6.4 mmol/L
  • Severe: ≥6.5 mmol/L
• One very common cause of ‘hyperkalaemia’ is lysed sample. Remeber to check lab formal report whether there is any documentation regarding lysed sample. In that case, it is better to repeat RP / potassium first before starting treatment for the ‘hyperkalaemia’.

• Not all hyperkalaemia cases require fast correction with lytic cocktail!
• Moderate / Severe hyperkalaemia warrants fast correction, but also depends on clinical condition

Lytic cocktail regime

• IV Calcium gluconate 10% over 10 minutes (ideally attach with cardiac monitor during administration), then
• IV Dextrose 50% 50 mL , then
• IV Actrapid 10 units (1 mL)

Repeat serum potassium 1 hour post lytic cocktail, may require repeated lytic cocktail / urgent haemodialysis if persistent severe hyperkalaemia

Oral Kalimate

• Dose example: PO Kalimate 15 g TDS for 3 days
• Do not give oral Kalimate for long term due to risk of bowel necrosis

Flowchart of emergency management of hyperkalaemia