What are the indications for urgent referral to secondary care in patients with hyperkalaemia?

Indications for urgent referral to secondary care in patients presenting with hyperkalaemia include:

• Serum potassium concentration greater than 5.5 mmol/L, especially if associated with symptoms or ECG changes.
• Presence of cardiac arrhythmias or signs of cardiac instability, such as ventricular arrhythmia or new ECG abnormalities.
• Severe hyperkalaemia that poses an immediate risk of life-threatening complications.
• Patients with underlying conditions that increase the risk of adverse outcomes, such as chronic kidney disease, heart failure, or adrenal insufficiency.
• Hyperkalaemia occurring in the context of acute illness or medication changes that may worsen potassium balance.
• Inability to tolerate or safely manage hyperkalaemia in primary care, including failure of oral potassium-lowering treatments or need for intravenous therapy.

Urgent referral is necessary to enable continuous ECG monitoring, rapid potassium correction, and specialist management of underlying causes to prevent fatal complications ¹,²,⁵.