Hyperkalemia is a life-threatening electrolyte emergency characterized by elevated serum potassium levels that can precipitate fatal cardiac arrhythmias and sudden cardiac arrest. It most commonly occurs in patients with acute kidney injury, advanced chronic kidney disease, dialysis dependence, metabolic acidosis, tissue breakdown, or medication-induced potassium retention.

At International Modern Hospital, hyperkalemia is managed using time-critical, evidence-based emergency protocols led by nephrology in close coordination with emergency medicine, cardiology, and critical care teams.

Management follows three simultaneous therapeutic priorities:

1. Immediate Cardiac Stabilization
Patients with moderate to severe hyperkalemia or ECG changes are immediately placed on continuous cardiac monitoring. Intravenous calcium gluconate or calcium chloride is administered to stabilize myocardial cell membranes and reduce arrhythmia risk. This step does not lower potassium levels but is crucial for preventing cardiac arrest.

2. Rapid Intracellular Potassium Shift
Therapies aimed at temporarily shifting potassium into cells include:

Intravenous insulin with glucose

Nebulized beta-agonists

Sodium bicarbonate in cases of metabolic acidosis

These measures act rapidly but are transient and must be followed by definitive potassium removal.

3. Definitive Potassium Removal
Potassium elimination is achieved through:

Loop diuretics (if residual renal function and volume status permit)

Potassium-binding agents

Emergency hemodialysis for severe, refractory, or dialysis-dependent patients

Dialysis is the most effective and definitive treatment for life-threatening hyperkalemia and is initiated without delay when indicated.

Throughout treatment, frequent laboratory monitoring ensures safe potassium correction and avoids rebound hyperkalemia. Underlying causes such as renal failure, rhabdomyolysis, acidosis, or medication toxicity are aggressively addressed.

This structured, ICU-capable approach ensures rapid correction, cardiac safety, and prevention of recurrence in critically ill patients.