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Refractory hyperkalaemia in acute kidney injury — SCE Acute Medicine MCQ

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HardRenal medicineRefractory hyperkalaemia in acute kidney injurySCE Acute Medicine

A 56-year-old man with diabetic nephropathy is admitted with pulmonary oedema, potassium 6.8 mmol/L and pH 7.18 despite initial medical treatment. He is anuric and creatinine is 690 micromol/L. ECG changes have improved after calcium and insulin-glucose, but potassium remains 6.7 mmol/L at two hours. What is the most appropriate next step in management?

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Correct answer: C — Arrange urgent renal replacement therapy

Refractory severe hyperkalaemia with anuria, acidosis and pulmonary oedema is an indication for urgent renal replacement therapy. Temporising treatments shift potassium but do not remove it sufficiently in anuric renal failure. ECG improvement after calcium is temporary and does not remove the need for definitive potassium control.

Reference: UK Kidney Association Hyperkalaemia Guideline 2023; NICE NG148