[Acute hyperkalemia management]

Hyperkalemia is an electrolyte disorder defined as a plasma potassium concentration greater than 5 mmol/L. Plasma potassium represents approximately 2 % of the total body potassium, and its regulation depends mainly on renal excretion and transcellular shifts. Various pathologies can alter potassium homeostasis and lead to acute or chronic hyperkalemia. The rate of change in plasma potassium concentration is critical because the faster it occurs, the faster life-threatening symptoms develop. Therefore, acute hyperkalemia should be urgently treated. There is no «threshold» value defining the severity of the situation, but the electrocardiographic changes appear to be valuable indicators of severity. Several medical associations have issued recommendations regarding the emergency management of hyperkalemia, but there is no scientific consensus. In this article, we summarize the current knowledge and propose a practical management algorithm for the management of acute hyperkalemia.