Patient handout

Hyperkalemia symptom-triage (ED workup + cross-engine to syndrome)

PRODUCTION

1. Your condition

This handout is for hyperkalemia symptom-triage (ed workup + cross-engine to syndrome). Your care team identified this based on: k ≥6.5 with ecg changes (peaked t → wide qrs → sine wave → asystole) — stat calcium gluconate 1 g iv (10 ml of 10%) over 2-3 min → membrane stabilization + insulin 10 u iv + d50 25 g + albuterol 10-20 mg neb + sodium bicarbonate if acidotic + binder + dialysis prep (nice 2020 verify; kdoqi 2020 verify).

Other reasons your team may use this plan: k 5.5-6.5 without ecg changes — moderate; insulin/d50 + albuterol + binder; recheck k + ecg q1-2h; cause workup; known ckd (egfr <45) + chronic hyperkalemia + acei/arb/mra — route neph.ckd.core.v1; chronic patiromer or sodium zirconium cyclosilicate for raas-inhibitor preservation (relief/amethyst/amber/harmonize trials — verify); acute cr rise + hyperkalemia + oliguria → route renal.aki.v1; cause-directed ivf if pre-renal, dialysis if anuric / refractory.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
calcium gluconate 10% 10 mL (1 g) IV over 2-3 min (repeat in 5 min if ECG unchanged); calcium chloride 10% via central line if peri-arrest	—	—	—	Does NOT lower K; antagonizes membrane excitability within minutes to prevent dysrhythmia while shift/elimination act (Turk J Emerg Med 2023)

Plan: Acute hyperkalemia: membrane stabilization → intracellular shift → elimination (Turk J Emerg Med 2023; ED management)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

K ≥6.5 with ECG changes (peaked T → wide QRS → sine wave → asystole) — STAT calcium gluconate 1 g IV (10 mL of 10%) over 2-3 min for membrane stabilization + insulin 10 U IV + D50 25 g + albuterol 10-20 mg neb + sodium bicarbonate if pH <7.2 + binder + dialysis prep (NICE 2020 verify; KDOQI 2020 verify)(life-threatening)
Cardiac arrest OR peri-arrest with confirmed hyperkalemia — ACLS + calcium chloride 1 g IV via central + insulin/D50 + bicarbonate + IMMEDIATE hemodialysis arrangement(life-threatening)
AKI (acute Cr rise + oliguria/anuria) + hyperkalemia → route renal.aki.v1; cause-directed IVF if pre-renal, dialysis if anuric / refractory medical mgmt
Recent chemotherapy (24-72 h) for high-burden malignancy (lymphoma, AML, ALL) + hyperK + hyperuricemia + hyperphosphatemia + hypocalcemia + LDH high — tumor lysis; rasburicase 0.2 mg/kg IV (check G6PD first) + IVF + binder; route heme.tumor-lysis-syndrome.core.v1
Hyperkalemia + hyponatremia + hypotension + steroid history OR hyperpigmentation / Addison features — adrenal crisis; STAT hydrocortisone 100 mg IV (empiric) + fluids → route endo.adrenal-crisis.core.v1(life-threatening)
Crush injury / exertional / statin / cocaine / heat stroke / seizure + hyperK + CK >5000 + myoglobinuria — rhabdomyolysis; aggressive NS 200-500 mL/h titrate UOP 200-300 mL/h + alkalinize urine pH >6.5 + monitor compartment syndrome

5. Follow-up

Nephrology for CKD / AKI / chronic binder; deprescribing offending meds (or substituting + binder for RAAS preservation); endocrinology for adrenal / type 4 RTA; oncology / heme for TLS prevention; dietary K counseling; recurrence prevention; K-binder education (patiromer, ZS-9)

6. Sources

Guideline: 2020 NICE hyperkalemia + 2020 KDOQI potassium + Cochrane insulin/glucose + AMETHYST-DN/AMBER/HARMONIZE patiromer + ZS-9 trials + ASCO/ESMO TLS + Endocrine Society adrenal