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Severe hyperkalaemia

Start this sheet when: Potassium 6.5 mmol/L or more, or 6.0 or more with ECG changes (peaked T, flat P, wide QRS, slow rate). Think of it in anyone on dialysis, with AKI, crush injury, DKA, or on ACE inhibitor, spironolactone or trimethoprim.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time since door

Targets met --Breaches 0

1.12-lead ECG done, on cardiac monitor
≤ 10 min from door · UKKA 2020: ECG and monitor at once
Enter door time
2.Potassium known (blood gas or lab)
≤ 30 min from door · Local target: blood gas K+ is fine to act on
Enter door time
3.Calcium given (10% gluconate 30 mL or chloride 10 mL)(ECG changes)
≤ 10 min from ECG · UKKA 2020: at once for ECG changes
N/AEnter door time
4.Insulin 10 units with glucose 25 g given
≤ 15 min from potassium result · UKKA 2020: K+ 6.5 or more
Enter door time
5.Salbutamol 10-20 mg nebulised(No fast arrhythmia)
≤ 15 min from potassium result · UKKA 2020: add-on to insulin-glucose
N/AEnter door time
6.Capillary glucose checked after insulin
≤ 30 min from insulin-glucose · UKKA 2020: 15, 30, 60, 90, 120 min, then hourly to 6 h
Enter door time
7.Repeat potassium
≤ 1 h from insulin-glucose · UKKA 2020: 1 h after insulin-glucose
Enter door time
8.Nephrology / dialysis called(Anuric, on dialysis, or K+ still 6.5+)
≤ 1 h from potassium result · Local target: removal plan in the first hour
N/AEnter door time
9.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
10.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Calcium protects the heart for 30-60 min; it does not lower K+
☐ECG still abnormal after 5-10 min: repeat the calcium
☐Glucose below 126 mg/dL before insulin: 10% dextrose 50 mL/h for 5 h
☐Remove it: furosemide if passing urine; dialysis if not; binders are slow
☐Stop ACE inhibitor, ARB, spironolactone, NSAID, trimethoprim, K+ supplements
☐Ask about 'low sodium' salt: it is potassium chloride
☐Haemolysed or hard draw? Recheck, but treat any ECG change now
☐Digoxin toxicity: digoxin antibody where available

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐Calcium protects the heart for 30-60 min; it does not lower K+

☐ECG still abnormal after 5-10 min: repeat the calcium

☐Glucose below 126 mg/dL before insulin: 10% dextrose 50 mL/h for 5 h

☐Remove it: furosemide if passing urine; dialysis if not; binders are slow

☐Stop ACE inhibitor, ARB, spironolactone, NSAID, trimethoprim, K+ supplements

☐Ask about 'low sodium' salt: it is potassium chloride

☐Haemolysed or hard draw? Recheck, but treat any ECG change now

☐Digoxin toxicity: digoxin antibody where available