{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:41:24Z","timestamp":1789951284494,"version":"4.0.1"},"reference-count":37,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2013,9,1]],"date-time":"2013-09-01T00:00:00Z","timestamp":1377993600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Royal College of Physicians of Edinburgh"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:p>Hyperkalaemia, an elevated extracellular fluid potassium concentration, is a common electrolyte disorder and is present in 1\u201310% of hospitalised patients. Elevated serum potassium concentrations are usually asymptomatic but may be associated with electrocardiogram (ECG) changes. Hyperkalaemia occasionally leads to life-threatening cardiac arrhythmias. Prompt recognition of this disorder, patient risk management and administration of appropriate treatment can prevent serious cardiac complications of hyperkalaemia. Further assessment of the underlying basis for hyperkalaemia usually reveals a problem with renal potassium excretion (rather than transcellular shift of potassium or excess potassium intake). Reduced potassium excretion is typically associated with decreased potassium secretion in the aldosterone-sensitive distal nephron of the kidney. Common causes for hyperkalaemia include kidney failure, limited delivery of sodium and water to the distal nephron and drugs that inhibit the renin-angiotensin-aldosterone system. Treatment of life-threatening hyperkalaemia (particularly those patients with ECG changes) involves administration of intravenous calcium salts to stabilise the resting cardiac membrane potential. The potassium concentration can be lowered by administration of intravenous insulin combined with an infusion of glucose to stimulate intracellular uptake of potassium. Nebulised \u03b2-2 adrenoceptor agonists can augment the effects of intravenous insulin and glucose pending more definitive management of the recurrent hyperkalaemia risk. Additional management steps include stopping further potassium intake and careful review of prescribed drugs that may be adversely affecting potassium homeostasis. Changes to prescribing systems and an agreed institutional protocol for management of hyperkalaemia can improve patient safety for this frequently encountered electrolyte disorder.<\/jats:p>","DOI":"10.4997\/jrcpe.2013.312","type":"journal-article","created":{"date-parts":[[2013,10,2]],"date-time":"2013-10-02T07:10:04Z","timestamp":1380697804000},"page":"246-251","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Management of hyperkalaemia"],"prefix":"10.1177","volume":"43","author":[{"given":"AP","family":"Maxwell","sequence":"first","affiliation":[{"name":"Professor of Renal Medicine, Queens University Belfast"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Linden","sequence":"additional","affiliation":[{"name":"Medical Student, University of Dundee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"O\u2019Donnell","sequence":"additional","affiliation":[{"name":"Medicines Governance Pharmacist, Belfast HSC Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PK","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Consultant in Acute Medicine, Belfast HSC Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GE","family":"McVeigh","sequence":"additional","affiliation":[{"name":"Professor of Cardiovascular Medicine, Queens University Belfast, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2013,9,1]]},"reference":[{"key":"bibr1-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"1 Paice B, Gray JM, McBride D  Hyperkalaemia in patients in hospital. Br Med J (Clin Res Ed) 1983; 286:1189\u201392. http:\/\/dx.doi.org\/10.1136\/bmj.286.6372.1189","DOI":"10.1136\/bmj.286.6372.1189"},{"key":"bibr2-JRCPE.2013.312","first-page":"557","volume":"102","author":"Moore ML","year":"1989","journal-title":"N Z Med J"},{"key":"bibr3-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"3 Nyirenda MJ, Tang JI, Padfield PL  Hyperkalaemia. BMJ 2009; 339: b4114. http:\/\/dx.doi.org\/10.1136\/bmj.b4114","DOI":"10.1136\/bmj.b4114"},{"key":"bibr4-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"4 Soar J, Perkins GD, Abbas G  European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010; 81:1400\u201333. http:\/\/dx.doi.org\/10.1016\/j. resuscitation.2010.08.015","DOI":"10.1016\/j.resuscitation.2010.08.015"},{"key":"bibr5-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"5 Einhorn LM, Zhan M, Hsu VD  The frequency of hyperkalaemia and its significance in chronic kidney disease. Arch Intern Med 2009; 169:1156\u201362. http:\/\/dx.doi.org\/10.1001\/archinternmed.2009.132","DOI":"10.1001\/archinternmed.2009.132"},{"key":"bibr6-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"6 Acker CG, Johnson JP, Palevsky PM  Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. Arch Intern Med 1998; 158:917\u201324. http:\/\/dx.doi.org\/10.1001\/archinte.158.8.917","DOI":"10.1001\/archinte.158.8.917"},{"key":"bibr7-JRCPE.2013.312","first-page":"307","volume":"109","author":"Perazella MA.","year":"2000","journal-title":"Drug-induced hyperkalemia: old culprits and new offenders"},{"key":"bibr8-JRCPE.2013.312","first-page":"26","volume":"158","author":"Reardon LC","year":"1998","journal-title":"Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors"},{"key":"bibr9-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"9 Sarafidis PA, Blacklock R, Wood E  Prevalence and factors associated with hyperkalemia in predialysis patients followed in a low-clearance clinic. Clin J Am Soc Nephrol 2012; 7:1234\u201341. http:\/\/dx.doi.org\/10.2215\/CJN.01150112","DOI":"10.2215\/CJN.01150112"},{"key":"bibr10-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"10 Lapi F, Azoulay L, Yin H  Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study. BMJ 2013; 346:e8525. http:\/\/dx.doi.org\/10.1136\/bmj.e8525","DOI":"10.1136\/bmj.e8525"},{"key":"bibr11-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"11 Sacchetti A, Stuccio N, Panebianco P  ED hemodialysis for treatment of renal failure emergencies. Am J Emerg Med 1999; 17:305\u20137. http:\/\/dx.doi.org\/10.1016\/S0735-6757(99)90131-6","DOI":"10.1016\/S0735-6757(99)90131-6"},{"key":"bibr12-JRCPE.2013.312","unstructured":"12Royal College of Physicians of London. National early warning score (NEWS): standardising the assessment of acute-illness severity in the NHS: report of a working party 2012 [Internet]. London: RCP London; 2012 [cited 2013 Apr 10]. Available from: www.rcplondon.ac.uk\/resources\/national-early-warning-score-news"},{"key":"bibr13-JRCPE.2013.312","unstructured":"13National Institute for Health and Clinical Excellence. Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital (CG50) [Internet]. London: NICE; 2007 [cited 2013 Apr 10]. Available from: www.nice.org.uk\/CG50"},{"key":"bibr14-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"14 Aslam S, Friedman EA, Ifudu O. Electrocardiography is unreliable in detecting potentially lethal hyperkalaemia in haemodialysis patients. Nephrol Dial Transplant 2002; 17:1639\u201342. http:\/\/dx.doi.org\/10.1093\/ndt\/17.9.1639","DOI":"10.1093\/ndt\/17.9.1639"},{"key":"bibr15-JRCPE.2013.312","first-page":"324","volume":"3","author":"Montague BT","year":"2008","journal-title":"Retrospective review of the frequency of ECG changes in hyperkalemia"},{"key":"bibr16-JRCPE.2013.312","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/45.7.1091"},{"key":"bibr17-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"17 Mahoney BA, Smith WA, Lo DS  Emergency interventions for hyperkalaemia. Cochrane Database Syst Rev 2005; 2:CD003235.","DOI":"10.1002\/14651858.CD003235.pub2"},{"key":"bibr18-JRCPE.2013.312","unstructured":"18British National Formulary. Calcium supplements [Internet]. London: BNF 2012 [cited 2013 Apr 10]. Available from: http:\/\/www.evidence.nhs.uk\/formulary\/bnf\/current\/9-nutrition-andblood\/95-minerals\/951-calcium-and-magnesium\/9511-calciumsupplements\/calcium-salts"},{"key":"bibr19-JRCPE.2013.312","unstructured":"19 Hack JB, Lewin NA. Cardiac glycosides. In: Goldfrank LR, Flomenbaum NE, Lewin NA et al (editors). Goldfrank\u2019s toxicologic emergencies. 7th edition. New York: McGraw-Hill; 2002."},{"key":"bibr20-JRCPE.2013.312","first-page":"41","volume":"40","author":"Levine M","year":"2011","journal-title":"The effects of intravenous calcium in patients with digoxin toxicity"},{"key":"bibr21-JRCPE.2013.312","first-page":"3246","volume":"36","author":"Weisberg LS.","year":"2008","journal-title":"Management of severe hyperkalemia"},{"key":"bibr22-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"22 Elliott MJ, Ronksley PE, Class CM  Management of patients with acute hyperkalemia. CMAJ 2010; 182:1631\u20135. http:\/\/dx.doi.org\/10.1503\/cmaj.100461","DOI":"10.1503\/cmaj.100461"},{"key":"bibr23-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"23 Allon M, Albuterol Copkney C., for insulin treatment of hyperkalemia in hemodialysis patients. Kidney Int 1990; 38:869\u201372. http:\/\/dx.doi.org\/10.1038\/ki.1990.284","DOI":"10.1038\/ki.1990.284"},{"key":"bibr24-JRCPE.2013.312","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(12)80983-8"},{"key":"bibr25-JRCPE.2013.312","first-page":"30","volume":"64","author":"Williams PS","year":"1988","journal-title":"Hypoglycaemia following treatment of hyperkalaemia with insulin and dextrose"},{"key":"bibr26-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"26 Kamel KS, Wei C. Controversial issues in the treatment of hyperkalaemia. Nephrol Dial Transplant 2003; 18:2215\u20138. http:\/\/dx.doi.org\/10.1093\/ndt\/gfg323","DOI":"10.1093\/ndt\/gfg323"},{"key":"bibr27-JRCPE.2013.312","first-page":"348","volume":"14","author":"Ahmed J","year":"2001","journal-title":"Hyperkalemia in dialysis patients"},{"key":"bibr28-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"28 Allon M, Shanklin N. Effect of bicarbonate administration on plasma potassium in dialysis patients: interactions with insulin and albuterol. Am J Kidney Dis 1996; 28:508\u201314. http:\/\/dx.doi.org\/10.1016\/S0272-6386(96)90460-6","DOI":"10.1016\/S0272-6386(96)90460-6"},{"key":"bibr29-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"29 Sterns RH, Rojas M, Bernstein P  Ion-exchnage resins for the treatment of hyperkalemia: are they safe and effective? J Am Soc Nephrol 2010; 21:733\u20135. http:\/\/dx.doi.org\/10.1681\/ASN.2010010079","DOI":"10.1681\/ASN.2010010079"},{"key":"bibr30-JRCPE.2013.312","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V9101924"},{"key":"bibr31-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"31 Moen MF, Zhan M, Hsu VD  Frequency of hypoglycemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol 2009; 4:1121\u20137. http:\/\/dx.doi.org\/10.2215\/CJN.00800209","DOI":"10.2215\/CJN.00800209"},{"key":"bibr32-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"32 Ljuti\u0107 D, Should glucose be administered before Rumboldt Z., with, or after insulin, in the management of hyperkalemia? Ren Fail 1993;15: 73\u20136. http:\/\/dx.doi.org\/10.3109\/08860229309065576","DOI":"10.3109\/08860229309065576"},{"key":"bibr33-JRCPE.2013.312","doi-asserted-by":"crossref","unstructured":"33 Blumberg A, Weidmann P, Shaw S  Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure. Am J Med 1988; 85:507\u201312. http:\/\/dx.doi.org\/10.1016\/S0002-9343(88)80086-X","DOI":"10.1016\/S0002-9343(88)80086-X"},{"key":"bibr34-JRCPE.2013.312","unstructured":"34The Renal Association. Treatment of acute hyperkalaemia in adults [Internet]. Hampshire: The Renal Association; 2012 [cited 2013 Apr 10]. Available from: http:\/\/www.renal.org\/Clinical\/GuidelinesSection\/Treatment-of-Acute-Hyperkalaemia-in-Adults.aspx"},{"key":"#cr-split#-bibr35-JRCPE.2013.312.1","unstructured":"35Department of Health (UK). The \"never events\" list for 2012\/13 [Internet]. London: DoH"},{"key":"#cr-split#-bibr35-JRCPE.2013.312.2","unstructured":"2012 [cited 2013 Apr 10]. Available from: http:\/\/www.dh.gov.uk\/en\/Publicationsandstatistics\/Publications\/PublicationsPolicyAndGuidance\/DH_132355"},{"key":"bibr36-JRCPE.2013.312","unstructured":"36Guidelines and Audit Implementation Network. Guidelines for the treatment of hyperkalaemia in adults [Internet]. Belfast: GAIN; 2009 [cited 2013 Apr 10]. Available from: http:\/\/www.gain-ni.org\/images\/Uploads\/Guidelines\/hyperkalaemia_guidelines.pdf"}],"container-title":["Journal of the Royal College of Physicians of Edinburgh"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/JRCPE.2013.312","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/JRCPE.2013.312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:26:34Z","timestamp":1777616794000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4997\/JRCPE.2013.312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9]]},"references-count":37,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2013,9]]}},"alternative-id":["10.4997\/JRCPE.2013.312"],"URL":"https:\/\/doi.org\/10.4997\/jrcpe.2013.312","relation":{},"ISSN":["1478-2715","2042-8189"],"issn-type":[{"value":"1478-2715","type":"print"},{"value":"2042-8189","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9]]}}}