Typical exam stem
A patient with acute kidney injury has potassium of 6.8 mmol/L and ECG changes. What are your immediate priorities?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What ECG changes can occur in hyperkalaemia?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Confirm severity but do not delay life-saving treatment
Severe hyperkalaemia can cause fatal conduction disturbance. Repeat a suspicious result when pseudohyperkalaemia is plausible, but a markedly elevated potassium with compatible ECG changes or clinical context should be treated immediately.
- Obtain ECG and continuous cardiac monitoring in severe cases.
- Review renal function, acid-base status, glucose and contributing medicines.
- Common causes include AKI, advanced CKD, tissue breakdown, acidosis, insulin deficiency and potassium-raising drugs.
Use the three-part emergency framework
- Protect the myocardium when ECG toxicity is present using intravenous calcium according to local emergency protocol.
- Shift potassium intracellularly using insulin with glucose, and add other temporising measures when indicated.
- Remove potassium from the body by addressing the cause, using potassium binders or diuresis when appropriate, and urgent dialysis when hyperkalaemia is refractory or renal failure is severe.
Reassessment is mandatory
The intracellular shift is temporary. Repeat potassium and glucose after treatment and continue ECG monitoring in severe cases. Review medications and the underlying renal or metabolic cause to prevent rebound hyperkalaemia.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.