Evaluation of hyperkalemia

Hyperkalemia is defined as significant when the serum potassium value >6.0 mEq/L (>6.0 mmol/L). Moderate hyperkalemia is defined as serum potassium values in the 5.0 to 6.0 mEq/L (5.0 to 6.0 mmol/L) range. Small changes in serum potassium values can have significant muscular and cardiac effects when significant hyperkalemia is present.

Hyperkalemia is most commonly due either to high intake of potassium in the setting of decreased renal excretion or to extracellular redistribution of potassium from intracellular locations. There is a limited correlation between an elevated serum potassium value and an excess in total body potassium stores. Clinical manifestations of hyperkalemia are uncommon with values <6.0 mEq/L (<6.0 mmol/L).

Common acute manifestations of significant hyperkalemia include muscle weakness and ECG changes, with the latter having the potential to progress to a life-threatening arrhythmia.[1]Mattu A, Brady WJ, Robinson DA. Electrocardiographic manifestations of hyperkalemia. Am J Emerg Med. 2000 Oct;18(6):721-9. http://www.ncbi.nlm.nih.gov/pubmed/11043630?tool=bestpractice.com ​​ Significant hyperkalemia represents a medical emergency, and an ECG should be obtained to establish whether cardiotoxicity is present. Continuous ECG monitoring should occur until serum potassium values have been brought into a safe range and cardiotoxicity has resolved.

Whereas the treatment of significant hyperkalemia is pre-emptive in the patient without electrocardiographic change, in the presence of electrocardiographic change significant hyperkalemia represents a true medical emergency and requires rapid implementation of measures to reduce serum potassium concentration.[Figure caption and citation for the preceding image starts]: ECG changes in patients with hyperkalemiaBMJ 2009; 339:b4114. Copyright ©2009 by the BMJ Publishing Group [Citation ends].