What are the indications for urgent referral to secondary care in a patient with severe hyperkalaemia?

Indications for urgent referral to secondary care in a patient presenting with severe hyperkalaemia include:

• Serum potassium concentration greater than 5.5 mmol/L, especially if associated with symptoms or ECG changes.
• Presence of cardiac arrhythmias or electrocardiogram abnormalities suggestive of hyperkalaemia (e.g., peaked T waves, widened QRS complex).
• Severe hyperkalaemia not responding to initial medical management.
• Hyperkalaemia associated with acute kidney injury or renal failure requiring specialist input or renal replacement therapy.
• Life-threatening symptoms such as muscle weakness, paralysis, or respiratory failure.
• Hyperkalaemia occurring during intravenous fluid therapy or in the context of other electrolyte disturbances requiring hospital monitoring.

Patients meeting these criteria should be referred immediately to secondary care for continuous ECG monitoring, intravenous treatment, and specialist management to prevent fatal complications.

References: NICE CKS, NICE NG148, NICE CG174