ICU SAQs · Electrolytes
Hyperkalaemia with ECG change — the fixed management sequence
A CICM Second-Part SAQ on the emergency sequence for hyperkalaemia with ECG change — calcium to stabilise the myocardium, insulin-dextrose and salbutamol to shift potassium into cells, and resins or renal replacement therapy to remove it — and the principle of treating on the number.
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Prompt
A 68-year-old man with chronic kidney disease presents with muscle weakness and an ECG showing peaking of the T waves and widening of the QRS at a serum potassium of 7.1 mmol/L. Outline your immediate management, explaining the purpose, the onset and the limitation of each step.
Question
A 68-year-old man with chronic kidney disease presents with muscle weakness and an ECG showing peaking of the T waves and widening of the QRS at a serum potassium of 7.1 mmol/L. Outline your immediate management, explaining the purpose, the onset and the limitation of each step. [3]
References3ShowHide
- [1]Kovesdy CP. Management of hyperkalaemia in chronic kidney disease. Nature Reviews Nephrology, 2014.PMID 25223988
- [2]Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International, 2020.PMID 31706619
- [3]Jessen MK, Andersen LW, Djakow J, et al. Pharmacological interventions for the acute treatment of hyperkalaemia: A systematic review and meta-analysis. Resuscitation, 2025.PMID 39761907