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Clinical features and investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Hyperkalaemia is often asymptomatic and is uncovered during routine laboratory testing (1).

Patients with severe hyperkalaemia may complain of non specific symptoms:

  • muscular function
    • paresthesiae
    • muscle weakness
    • fatigue
  • cardiac function
    • arrhythmias
    • chest pain mimicking myocardial infarction, along with sweating, nausea, vomiting, extreme lethargy, weakness and giddiness (1,2)

The following investigations can be used for evaluation of suspected hyperkalaemia:

  • repeat serum measurement of potassium to identify pseudohyperkalaemia
  • other laboratory studies include:
    • blood biochemistry for kidney function - serum creatinine, S. urea, BUN etc
    • urine electrolytes and creatinine
    • arterial blood gas analysis
  • further investigations may be necessary to examine co-existing illnesses:
    • measurement of serum glucose - to evaluate for hyperglycemia
    • measurement of serum renin, aldosterone, and cortisol - to further investigate kidney and adrenal function
  • consider urgent ECG in patients with
    • a serum potassium >6.0mmol/L (severe hyperkalaemia can still be present in patients without obvious ECG changes)
    • symptoms of hyperkalaemia
    • suspicion of rapid-onset hyperkalaemia
    • underlying kidney disease, heart disease, or cirrhosis who have a new case of hyperkalaemia (2,3)

Note that emergency treatment is necessary if the serum potassium rises above 7.0 mmol/l or if there are ECG changes associated with hyperkalaemia.


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