Red flags
- ECG changes (tall T, wide QRS, sine wave)
- Cardiac arrest
- K+ >6.5
First steps
- ECG
- Repeat K+ (exclude haemolysis)
- IV access
Key investigations
- ECG, U&E, glucose, ABG
- Digoxin level if applicable
Differentials
- Pseudohyperkalaemia (haemolysis)
- AKI, drug-induced
- Rhabdomyolysis, tumour lysis
Initial management
- Protect: calcium gluconate 10% 30 mL IV over 5 min if ECG changes
- Shift: insulin 10 U + 50 mL 50% dextrose IV; salbutamol nebs 10-20 mg
- Remove: patiromer PO, loop diuretic, haemodialysis if refractory/severe
- Stop ACEi/ARB/MRA/K supplements
Referral
- Renal for urgent dialysis if refractory
AI clinical assessment
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This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
