Guidelines for the Treatment of Hyperkalaemia in Hospitalised Adults - The Regulation and Quality Improvement Authority (RQIA)

Guidelines for the Treatment of Hyperkalaemia in Hospitalised Adults - The Regulation and Quality Improvement Authority (RQIA)

Hyperkalaemia is a common electrolyte disorder. The reported incidence of hyperkalaemia in hospitalised in patients is between 1% and 10%. It is arguably the most serious of all electrolyte abnormalities as the symptoms can be non-specific or absent, even in severe hyperkalaemia, before causing cardiac arrest. The common predisposing factors are kidney failure and drugs. Many cases are associated with medicines known as renin-angiotensin-aldosterone system inhibitors (RAASi) or other medicines that interfere with renal potassium excretion. Hyperkalaemia usually occurs in the setting of chronic kidney disease and/or acute kidney injury.

This guideline updates the previous 2014 GAIN Guideline for the Treatment of Hyperkalaemia in Adults. The major changes in the updated guidance are revised recommendations for monitoring of blood glucose before and after treatment of hyperkalaemia. This change is in recognition of the risk of hypoglycaemia in patients receiving insulin and glucose as part of the treatment for hyperkalaemia.

The instructions accompanying the hyperkalaemia kit have been updated to provide concise information that will enable doctors to effectively manage patients presenting with hyperkalaemia. In particular, the safe and effective use of insulin and glucose in the treatment of hyperkalaemia is highlighted, the requirement to always use an insulin syringe in drawing up insulin is emphasized and the importance of having a check of insulin dose by a senior nurse before insulin is administered to the patient is outlined. Blood glucose monitoring before and after treatment of hyperkalaemia is an essential component of the overall management of the patient.


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