Moderate to severe hyperkalemia
ICD-10 E87.5 · ICD-11 5C76

Managing Moderate to Severe Hyperkalemia During Cardiac Arrest When Serum K⁺ ≥ 6.5 mmol/L

When cardiac arrest occurs and serum potassium is at or above 6.5 mmol/L, hyperkalaemia must be actively considered as the precipitating cause. Recognising this at or near the time of arrest opens a narrow window for targeted intervention alongside resuscitation.

Clinical Scenario

Cardiac arrest where hyperkalaemia (serum K⁺ ≥ 6.5 mmol/L) is the known or suspected cause. When this potassium threshold is reached before or early in the resuscitation attempt, hyperkalaemia should be considered the potential underlying aetiology driving the arrest.

Approach Overview

Management integrates with standard advanced life support practice. Both intravenous calcium and an insulin-glucose combination are among the key acute interventions in this setting. The complete sequence, additional steps, and criteria for each intervention are detailed in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens
If the serum potassium is ≥ 6.5 mmol/L before or early in the resuscitation attempt, hyperkalaemia should be considered to be the potential cause of the cardiac arrest.
We recommend that intravenous calcium chloride is administered if hyperkalaemia is known or suspected to be the cause of cardiac arrest.
We recommend that standard ALS practice in cardiac arrest be applied to patients requiring dialysis.
We recommend that 10 units soluble insulin and 25g glucose is administered if hyperkalaemia is known or suspected to be the cause of cardiac arrest.
We suggest 10% glucose infusion be initiated if the blood glucose is < 7.0 mmol/l at the time of cardiac arrest.
View source ↗