Hyperkalaemia (inpatient)

This guidance is predominantly for the management of hyperkalaemia in hospital.

See also our pages on management of hyperkalaemia in the community.

Treatment of Acute Hyperkalaemia

Additional Considerations

Dietary intake: 

Dietary intake of potassium may explain acute hyperkalaemia, particularly in patients with advanced CKD and ESRF. Dietary restriction of potassium is important for prevention of hyperkalaemia. See Diet advice.

Potassium binders:

  • Calcium Resonium – Not useful in the acute setting but may be a short to medium term option if dialysis is not desirable or possible. Poorly tolerated due to constipation.
  • Patiromer Calcium – Relatively new medication for hyperkalaemia. Onset of action 4-7 hours. Acts as a potassium binder within the GI tract. As with resonium, side effects include abdominal pain and constipation.
  • Sodium Zirconium Cyclosilicate is recommended as an option for treating hyperkalaemia in adults in outpatient care for people with persistent moderate hyperkalaemia in the context of CKD if they have a confirmed serum potassium level of at least 6.0 mmol/L and are not taking an optimised dosage of renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia and are not on dialysis. It is not yet widely used within NHS Lothian. 


Acknowledgements:   Liam Plant was the main author for this page. It was updated by Ashley Simpson in November 2020. The last modified date is shown in the footer.