Assessment of hyperkalaemia

  • Not usually a problem unless the patient becomes unresponsive (a late sign of serious organ impairment).

  • May have tachypnoea due to arrhythmias and palpitations.

  • Heart rate - tachycardia, bradycardia or arrhythmia.

    ECG - peaked T waves, absent or flattened P waves, broad QRS complexes, sine wave, VF or asystole.

    May have reduced urine output (if AKI or CKD).

  • GCS may be reduced.

  • May have muscle spasms and weakness.

Secondary data: ABG/VBG/point of care blood gas analyser - if the K+ ≥5.5mmol/L, then send baseline bloods – U+Es creatinine, urea and take ECG.

ECG changes associated with hyperkalaemia

  • Peaked T-waves on its own should not be an automatic indication for urgent therapy.

  • The ECG does not always demonstrate changes, even in the presence of severe hyperkalaemia, so a normal ECG does not remove the need for treatment.