History Consistent with

Management Algorithm for Adults •

Hyperkalemia?
History of DM, CHF, CKD or No
Repeat K Testing
Consider spurious

with Hyperkalemia
and pseudo-HK
• Labs showing acidosis or elevated Cr (signs
of renal failure) or

(K> 5.5 mEq/L)

• Patient on medications known to cause
hyperkalemia
Yes No
Yes K>5.5mEq/L? EXIT
*All disposition and treatment recommendations should account for local standards of care and
should not supersede the clinical judgement of the treating physician.
New ECG Changes?

Recommended Doses for Acute Care Settings: • Arrhythmia (bradycardia, non-sinus

tachycardia, junctional rhythm)
Calcium Gluconate: 1 gram; Calcium Chloride: 1 ampule Consider Emergent Yes
Insulin (regular)/Dextrose: Hemodialysis • Prolonged Intervals (PR or QRS)
5 units (insulin naïve or CKD) ;10 units (not naïve)/ D50 1- 2 amps.
Repeat POC glucose in 30 mins & q1hr • Diminished P Wave amplitude ST or T
Albuterol: 10mg Nebulizer over 15mins
Wave Changes (elevation, depression,
Loop Diuretics: Adjust for GFR peaked T)
Bumetanide Dose: 1-2 mg IV once.
Furosemide Dose: 20-80 mg IV once.
Torsemide Dose: 10-40 mg IV once.
No
Oral binders:
Sodium Zirconium Cyclosilicate 10-30 gm,
Patiromer 8.4g - 25.2g
SPS sodium polystyrene sulfonate 30 g Calcium Dosing
No • Give 1 gm IV push Calcium
Selection of therapeutic agents should account for safety profile,
availability, route of administration, tolerability, and patient clinical status. Yes Re-assessment
Gluconate
• Repeat ECG in 5 minutes.
K<6mEq/L? • If ECG changes persist, may repeat
calcium gluconate x 2

Treatment Options‡

Disposition K < 6 - Consider insulin/dextrose + albuterol ± oral

binders ± furosemide/fluids*.
Admit:
1. HK with unstable vitals K: 6-6.5 – Administer insulin/dextrose + albuterol ±
2. New onset HK furosemide/fluids*. Consider oral binders ± urgent
hemodialysis.
Discharge (consider): After 2-4 hrs
1. Chronic HK with K > 6.5 – Administer insulin/dextrose + albuterol ±
• stable vitals and ECG & furosemide/fluids*. Consider oral binders. Arrange
• K eliminated with binder or diuretics & for immediate hemodialysis.
• close follow up &
• Risk/benefit, shared decision of dc ‡ Consider bicarbonate for metabolic acidosis
discussed *Loop diuretics: use when eGFR≥45; Fluids: when eGFR≥45
and patient does not have CHF.
HK – hyperkalemia; K – serum potassium; DM – diabetes mellitus; CHF – congestive heart failure; CKD – chronic kidney disease; Cr – creatinine; ECG – electrocardiogram; IV – intravenous; dc – discharge;