ABSTRACT
The mechanisms of hyperkalaemia are as follows: excessive potassium intake; inadequate renal potassium excretion; and redistribution of potassium from the intracellular to the extracellular space. Since the vast majority of potassium is stored in the intracellular compartment, hyperkalaemia may reflect the redistribution of potassium into the extracellular space, rather than increased total body potassium. Severe hyperkalaemia must be corrected as a matter of urgency, due to its potential to cause life-threatening cardiac arrhythmias, culminating in asystole. The treatment priorities are as follows: protect against cardiac arrhythmias; and lower the serum potassium concentration. The danger is more pronounced when potassium levels rise acutely. Nebulised salbutamol acts to shift potassium into the intracellular compartment, due to its b-agonist effects.Correction of metabolic acidosis, if present, with IV sodium bicarbonate may also serve to lower the serum potassium concentration by causing redistribution of potassium into the intracellular compartment.
