From the Guidelines
Serum potassium levels above 6.5 mmol/L are considered potentially lethal and require immediate medical attention, as they can cause cardiac arrhythmias and cardiac arrest, with the risk of mortality increasing significantly at levels above 7.0 mmol/L. According to the most recent guidelines from the American Heart Association, hyperkalemia is a potentially lethal electrolyte disturbance that can occur due to renal failure or release of potassium from cells, and can cause cardiac arrhythmias and cardiac arrest 1. The clinical signs associated with severe hyperkalemia include flaccid paralysis, paresthesia, depressed deep tendon reflexes, or shortness of breath, and early electrocardiographic signs include peaked T waves on the ECG followed by flattened or absent T waves, prolonged PR interval, widened QRS complex, deepened S waves, and merging of S and T waves 1.
Some key points to consider in the management of hyperkalemia include:
- The importance of prompt recognition and treatment of hyperkalemia, as delayed treatment can lead to increased morbidity and mortality
- The use of calcium gluconate to stabilize cardiac membranes, insulin with glucose to shift potassium into cells, sodium bicarbonate if acidosis is present, and potentially dialysis for definitive removal of excess potassium
- The need for close monitoring of electrocardiogram changes, such as peaked T waves, widened QRS complexes, and sine wave patterns, which can precede cardiac arrest in severe hyperkalemia 2.
It is essential to note that the risk of mortality increases significantly with levels above 7.0 mmol/L, especially if the rise in potassium is rapid rather than gradual, and that patients with severe hyperkalemia require immediate medical intervention 1.
From the Research
Definition and Severity of Hyperkalemia
- Hyperkalemia is defined as a serum potassium level greater than 5.5 mmol/l 3
- It is a potentially lethal electrolyte disturbance that can result in morbidity and mortality if not managed appropriately 4, 5
- The most severe effect of hyperkalemia includes various cardiac dysrhythmias, which may result in cardiac arrest and death 4
Lethal Levels of Serum Potassium
- A serum potassium level above 7 mEq/l is considered life-threatening 6
- Levels above 7.5 mEq/l are associated with a high risk of fatal hyperkalemia 6
- In general, hyperkalemia can be deadly, and treatment requires specific measures including membrane stabilization, cellular shift, and excretion 4
Factors Contributing to Hyperkalemia
- Certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others, can lead to hyperkalemia 3
- Drug-induced hyperkalemia is a common cause of increased potassium levels in everyday clinical practice 7
- A wide range of drugs can cause hyperkalemia by interfering with potassium homeostasis, promoting transcellular potassium shift, or impairing renal potassium excretion 7