- Is the patient well? Full set of obs and NEWS2?
- Is it haemolysed or a repeat? When was the last result?
- Do they have AKI, take ACEi/ARB, spironolactone, potassium supplements or trimethoprim?
- Is there a cardiac monitor or an ECG?
Do now
- 12-lead ECG now and a cardiac monitor
- Urgent VBG for a fast potassium
- Stop potassium-raising drugs and potassium-containing fluids
- Treat the cause (AKI, DKA, drugs)
Key doses
- ECG changes: calcium gluconate 10% 30 mL IV over 5–10 min
- K⁺ ≥ 6.5: 10 units soluble insulin in 25 g glucose IV over 15 min + CBG monitoring
- Salbutamol 10–20 mg nebulised
- Pre-treatment glucose < 7: 10% glucose 50 mL/h for 5 h
Typical adult doses — always check the BNF and your local guideline.
Call your senior if
- K⁺ ≥ 6.5 or any ECG changes
- Not falling after treatment
- With AKI, oliguria or acidosis — renal / ITU
Think of
- Pseudohyperkalaemia (haemolysed / delayed sample)
- AKI
- Drugs
- DKA
- Rhabdomyolysis
Go deeper
The full walkthroughs behind this call.