Acute hyperkalaemia in emergency care: evidence-based approaches
Niclas Geldermann1, Julia Dzimiera2, Henning Fischer2
1Emergency Medicine, Luzerner Kantonsspital, Lucerne, Switzerland ngeldermann@web.de.
Emergency Medicine Journal : EMJ
|January 8, 2026
Summary
Emergency management of acute hyperkalaemia requires prompt recognition and treatment to prevent life-threatening complications. Key strategies include calcium, insulin-glucose, and beta-agonists, with evolving roles for newer agents and dialysis.
Area of Science:
- Emergency Medicine
- Nephrology
- Internal Medicine
Background:
- Acute hyperkalaemia is a common, life-threatening electrolyte imbalance in emergency departments.
- Timely intervention is crucial to prevent cardiac arrhythmias and mortality.
Purpose of the Study:
- To review evidence-based recommendations for emergency hyperkalaemia management.
- To address practical challenges and clinical uncertainties in acute care settings.
Main Methods:
- A selective literature search of PubMed, EMBASE, and international guidelines.
- Focus on clinical studies in emergency or acute care settings.
Main Results:
- Intravenous calcium is indicated for ECG changes or potassium ≥6.5 mmol/L.
- Insulin-glucose and inhaled beta-agonists (salbutamol) are effective for potassium shifting.
- Sodium bicarbonate use is limited; diuretics support elimination but lack strong evidence.
- Older binders (sodium polystyrene sulfonate) are not recommended; newer binders show promise.
- Haemodialysis is definitive for refractory cases or end-stage renal disease.
Conclusions:
- Current guidelines emphasize calcium, insulin-glucose, and beta-agonists for acute hyperkalaemia.
- Newer potassium binders require further validation in emergency settings.
- Management strategies must balance efficacy, safety, and patient-specific factors.
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