REBEL Core Cast 125.0 – Hyperkalemia

Hyperkalemia represents the most frequent electrolyte disorder in emergency medicine, necessitating a systematic approach to stabilization and treatment. While pseudohyperkalemia remains the leading cause, clinicians must prioritize screening patients with renal impairment or massive cell death using 12-lead ECGs. Management follows a three-step hierarchy: stabilizing cardiac myocytes with calcium salts to prevent lethal dysrhythmias, shifting potassium intracellularly using insulin or high-dose inhaled albuterol, and eliminating the ion through dialysis or forced diuresis. Notably, classic ECG changes like peaked T waves or QRS widening do not always occur serially, requiring high vigilance even with minor abnormalities. For patients capable of producing urine, balanced fluids like lactated Ringers are preferred over sodium chloride to avoid hyperchloremic acidosis, which can exacerbate potassium shifts. Rapid mobilization of dialysis remains the definitive intervention for anuric patients exhibiting significant cardiac manifestations.