From the Guidelines
An outpatient with a potassium level of 6 mEq/L requires immediate presentation to the emergency department, as hyperkalemia at this level is potentially life-threatening and can lead to dangerous cardiac arrhythmias, including ventricular fibrillation and cardiac arrest. According to the most recent and highest quality study, 1, acute hyperkalemia is defined as a serum K+ concentration exceeding the upper limit of normal that is not known to be chronic, and management depends on the magnitude or severity of the increase in K+ concentration, especially when combined with marked electrocardiographic (ECG) changes and severe muscle weakness.
Key Considerations
- The symptoms of hyperkalemia can be nonspecific, and although recommended for determining hyperkalemia, ECG findings can be highly variable and not as sensitive as a laboratory test in predicting hyperkalemia or its associated complications 1.
- Treatment options for acute hyperkalemia include intravenous calcium gluconate, insulin/glucose, inhaled β-agonists (eg, salbutamol), intravenous sodium bicarbonate, and hemodialysis 1.
- While awaiting transport to the ED, the patient should avoid foods high in potassium and stop any medications that may increase potassium levels, such as potassium supplements, ACE inhibitors, ARBs, potassium-sparing diuretics, and certain NSAIDs.
Emergency Department Treatment
- Treatment typically includes calcium gluconate to stabilize cardiac membranes, insulin with glucose to shift potassium into cells, sodium bicarbonate if acidotic, and possibly sodium polystyrene sulfonate or patiromer to enhance potassium elimination.
- ECG monitoring is essential to watch for signs of cardiac toxicity such as peaked T waves, widened QRS complexes, or loss of P waves.
- The underlying cause of hyperkalemia, which may include kidney dysfunction, medication effects, or adrenal insufficiency, will need to be identified and addressed during treatment, as highlighted in the expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors 1.
From the Research
Outpatient Management of Hyperkalemia
- Hyperkalemia is a common electrolyte disorder that can result in morbidity and mortality if not managed appropriately 2.
- The condition is usually detected via serum clinical laboratory measurement, and the most severe effect of hyperkalemia includes various cardiac dysrhythmias, which may result in cardiac arrest and death 2.
- Treatment includes measures to "stabilize" cardiac membranes, to shift K+ from extracellular to intracellular stores, and to promote K+ excretion 2.
Emergency Department Presentation
- Hyperkalemia can be deadly, and treatment requires specific measures including membrane stabilization, cellular shift, and excretion 2.
- Indications for urgent treatment include severe or symptomatic hyperkalemia, abrupt changes in potassium levels, electrocardiography changes, or the presence of certain comorbid conditions 3.
- Emergent treatment is recommended for patients with clinical signs and symptoms (e.g., muscle weakness, paralysis) or if electrocardiography abnormalities are present 4.
Potassium Level of 6 mmol/L
- A potassium level of 6 mmol/L is considered hyperkalemia, which is a condition where a serum potassium level is >5.5 mmol/l 5.
- Hyperkalemia is associated with fatal dysrhythmias and muscular dysfunction, and certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others, can lead to hyperkalemia 5.
- However, there is no specific evidence to suggest that a potassium level of 6 mmol/L requires immediate presentation to the emergency department (ED) unless the patient is symptomatic or has electrocardiography changes 3, 4.