This protocol addresses severe or symptomatic hyperkalemia — serum potassium greater than 6.5 mmol/L, or a patient presenting with muscular weakness and/or ECG changes such as peaked T waves — where hourly potassium monitoring has not confirmed an adequate reduction with the initial management step.
If initial treatment with glucose and insulin, inhaled salbutamol, or sodium bicarbonate (where indicated) has failed to achieve the treatment goal — a confirmed reduction in serum potassium level on hourly monitoring — this next-line protocol provides the structured approach for what to do next.
At this stage, the clinical focus shifts to actively removing potassium from the body rather than redistributing it. Specific agents directed at elimination are involved, and in certain clinical situations an urgent intervention beyond pharmacological management may be required.
The complete structured regimen — including agent selection, sequencing, decision points, and monitoring — is available in the full protocol.
Reduction in serum potassium level, confirmed on hourly monitoring.