ICU Map

Hyperkalemia

From confirming true hyperkalemia to stabilizing, shifting, and eliminating potassium.

RecognizeAssessDecideDifferentialInterveneReassess
Hyperkalemia
Assessment StepConfirm true hyperkalemia
Exclude a hemolyzed sample or severe leukocytosis/thrombocytosis (pseudohyperkalemia); repeat the level if it's unexpected for the clinical picture.
Decision PointGet an ECG immediately
Peaked T waves, PR prolongation, QRS widening, and a sine-wave pattern — ECG changes determine urgency more than the potassium number itself.
Differential Branches (2)
1Branch
Decision PointECG changes present
Treat this as a cardiac emergency and move through stabilization, shifting, and elimination in sequence.
Clinical ActionStabilize the myocardium
IV calcium gluconate or calcium chloride antagonizes the membrane effects of hyperkalemia — it does not lower the serum potassium.
Clinical ActionShift potassium intracellularly
IV insulin with dextrose, and nebulized/inhaled beta-agonist as an adjunct.
Clinical ActionRemove potassium from the bodyExplore Topic
Loop diuretic if renal function allows, potassium binders, or urgent dialysis if refractory or in the setting of AKI/ESRD.
2Branch
Decision PointNo ECG changes
Still treat and investigate, but without the same immediate cardiac-stabilization urgency.
Diagnosis / EtiologyIdentify and treat the causeExplore Topic
Review medications (ACE inhibitors/ARBs, potassium-sparing diuretics, NSAIDs) and assess renal function.

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • A sine-wave ECG pattern or hemodynamic instability — give calcium and escalate immediately; do not wait for a repeat potassium level.
  • Hyperkalemia refractory to shifting agents in a patient with AKI or ESRD — arrange urgent dialysis rather than repeating medical therapy.

Related Bedside Clinical Problems (13)

Bedside Presentations
New Tachycardia & Tachyarrhythmias

Algorithmic triage of acute heart rates > 100–150 bpm: stability screen (immediate cardioversion if unstable), narrow vs wide QRS differentiation, Brugada VT rules, and sinus tachycardia etiology search.

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New Bradycardia & Conduction Blocks

Acute bradyarrhythmia management: identifying hemodynamic instability, distinguishing sinus node arrest vs high-grade AV block, medical chronotropic support (atropine, epinephrine), and emergent pacing.

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Rapidly Progressive Weakness / Impending Ventilatory Failure

Bedside assessment and airway decision-making in rapidly ascending or fatiguable weakness risking ventilatory pump failure.

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Linked Deep-Dive Topics (2)

Reference Knowledge
Severe Hyperkalemia in Critical Illnessrenal

Nernst resting potential mechanics, ECG progression, the 3-step resuscitation framework (Stabilize, Shift, Eliminate), and post-dialysis rebound kinetics.

Explore Topic →
Acute Kidney Injury in Critical Carerenal

Sepsis-AKI microcirculatory decoupling, KDIGO staging, Furosemide Stress Test (FST), urine microscopy, and the AEIOU dialysis threshold framework.

Explore Topic →

Evidence status

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