1. Protect the heart: 

• Give calcium gluconate 10% IV over 3 mins.

2. Shift potassium back into cells:  

• 10u insulin in 100mls 20% glucose over 30mins via volumetric pump.

• Consider salbutamol nebulisers.

• Sodium bicarbonate if acidaemia is present.

• Remove potassium from body:

  • If hyperkalaemia persists will likely need dialysis / haemofiltration

3. Monitor potassium and glucose :

• Monitor at baseline, 60, 120, 240 & 360 minutes for minimum of 6 hours.

• Monitor for hypoglycaemia.

• To prevent recurrence and stop further potassium accumulation, consider the following:

  • Low K+ diet, avoid drugs know to raise K+, treat hypotension, ensure the patient is adequately hydrated, consider loop diuretics, K+ removal from gut via administration of the drug calcium resonium.