Hyperkalemia / Tumor LysisICU / resuscitation

Nephrology · Ward Pathways · Free — no sign-in

Post-chemo: ↑K, ↑PO₄, ↑uric acid, ↓Ca; peaked T / wide QRS

ABCDE

ECG now; calcium to stabilise myocardium; insulin/dextrose + salbutamol to shift; remove K⁺; dialysis if refractory.

Calculators:
  1. Prevent (TLS): Hydration + Allopurinol (Rasburicase if high-risk / allopurinol-allergic)
  2. Hyperkalemia + ECG changes → Calcium gluconate/chloride IV (protect heart)
  3. Shift: Insulin 10 U IV + D50; nebulized salbutamol 10–20 mg; bicarbonate only if concurrent significant metabolic acidosis (not routine)
  4. Remove: loop diuretic (if making urine); sodium zirconium cyclosilicate (SZC) 10 g PO TID up to 48 h (then 5–10 g/d) or patiromer 8.4–25.2 g PO as adjuncts; dialysis if refractory. Avoid SPS/Kayexalate acutely
Decision tree
ECG changes or K⁺ >6.5?
Yes
Calcium gluconate NOW → insulin/dextrose + salbutamol → remove K⁺ (SZC/patiromer/diuretic) → dialysis if refractory
No
K⁺ 6.0–6.5?
Yes
Insulin/dextrose ± salbutamol; treat cause; recheck
No
Treat cause; dietary/medication review; monitor

Order set

  • ECG NOW
  • K⁺, Ca, PO₄, uric acid
  • U&E
  • Calcium gluconate + insulin/glucose
  • Hydration + allopurinol/rasburicase
  • Rasburicase contraindicated in G6PD deficiency (hemolysis/methemoglobinemia)

Escalate / ICU

  • K⁺ >6.5 or ECG changes
  • Refractory to medical therapy → dialysis
  • Oliguric AKI

Criteria

AdmitAll significant hyperkalaemia/TLS
ICUECG changes, refractory hyperkalaemia
DialysisK⁺ >6.5 refractory, oliguric AKI, severe TLS
DischargeK⁺/uric acid controlled, renal function stable, prophylaxis ongoing
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
  • ECG changes
  • K⁺ >6.5
  • Oliguria
Differentials
  • Pseudohyperkalaemia
  • AKI
  • Acidosis
  • Drugs
Common mistakes
  • Treating number not ECG
  • Forgetting to remove K⁺ (only shifting)
Disposition & follow-up

Stabilise → shift → remove; dialysis if refractory.

Discharge package
MedicationsReview K⁺-raising drugs; TLS prophylaxis if ongoing; do NOT stop RASi solely for K⁺ — use binders/diuretics to enable continuation (KDIGO 2024)
Follow-upRecheck K⁺/renal
LifestyleLow-potassium diet if advised
Warning symptomsPalpitations, weakness
💊 Treatment detail — doses & preparation
Calcium gluconate 10%membrane stabiliser
Dose10–30 mL of 10% IV over 2–5 min for hyperK ECG changes; repeat q10 min ×3 PRN
Preparation10 mL ampoules (2.2 mmol Ca²⁺ each), undiluted slow push with cardiac monitor
MonitorECG immediately (QRS narrows); effect 1–3 min, lasts 30–60 min — shift/remove K⁺ in parallel
Insulin + dextrose (hyperK)K⁺ shift therapy
Dose10 units regular insulin IV + 25 g dextrose (50 mL of 50%), onset 15–30 min, lasts 4–6 h
Preparation50 mL 50% dextrose push + 10 U insulin; if glucose >14, give insulin alone; add 10% dextrose infusion if needed
MonitorCapillary glucose q15–30 min ×2 h (hypoglycaemia), K⁺ at 1–2 h
Salbutamol (albuterol)SABA
DoseHyperkalemia: 10–20 mg nebulized over 10 min (adjunct to insulin; onset ~30 min, lowers K ~0.5–1 mmol/L). Asthma: 2.5–5 mg q15–20 min ×3 then q1–4h
Preparation2.5/5 mg nebules + O₂-driven nebuliser at 6–8 L/min
MonitorHR, tremor, K⁺ (shifts intracellularly — used in hyperK), SpO₂
Sodium bicarbonate 8.4%alkalising agent
DoseTCA: 1–2 mmol/kg IV bolus then infusion to pH 7.50–7.55. Salicylate: urine alkalinisation pH 7.5–8.5
PreparationBolus 50–100 mL of 8.4% (1 mmol/mL); infusion 150 mmol in 1 L D5W + 20–40 mmol KCl
MonitorABG, K⁺ (hypokalaemia blocks alkalinisation), ionised Ca²⁺, volume
Furosemide IVloop diuretic
Dose40–80 mg IV slow push; infusion 5–40 mg/h in refractory congestion
Preparation20 mg/2 mL ampoule undiluted over 2–5 min (ototoxic if fast); infusion 250 mg in 50 mL NS via pump
MonitorUrine output, K⁺, Mg²⁺, creatinine, volume status
📖 UK Renal / KDIGO 2024 / TLS expert guidanceReviewed July 2026

← Central Diabetes Insipidus  ·  Renal Tubular Acidosis →

More Nephrology pathways

Part of Nephrology in Ward Pathways — open the interactive version.

ICU Decoded — original critical-care and internal-medicine pathways by Dr Javed Akhtar, each cited to a current guideline. For education and quick reference; verify every dose against local protocols before prescribing.

Open the app · Ward Pathways — 113 free cases · ICU Decoded chapters · Aladin Chirag bedside tools

About · Medical disclaimer · Privacy · Contact