[Acute disorders of potassium homeostasis : Diagnosis and emergency treatment]

Potassium disorders are common in patients treated in emergency departments or intensive care units and are associated with increased mortality. Severe hyperkalemia but also severe hypokalemia can lead to fatal arrhythmias and therefore necessitate emergency treatment. This article gives guidance on the diagnostic and therapeutic approach in patients with acute dyskalemia. Correct diagnosis requires not only a reliable measurement of serum potassium concentration but also knowledge of changes to the electrocardiogram caused by dyskalemia. This article outlines key steps in the treatment of hyperkalemia, including cardioprotection, shifting potassium into cells, and removing potassium from the body. Important pitfalls of potassium replacement in hypokalemia and the further approach after completion of initial emergency treatment are also reviewed.