Immediate hospital-level management: A potassium of 6.4 mmol/L is below the source’s stated threshold of >6.5 mmol/L requiring immediate attention, but it is close enough to warrant urgent assessment, repeat potassium measurement, 12-lead/continuous ECG monitoring, and measurement of urea, electrolytes, and creatinine. SmPC Potassium
Stop potassium loading: Withdraw all potassium-containing drugs and discontinue potassium-sparing diuretics. SmPC Potassium
If ECG changes, arrhythmia, or potassium rises above 6.5 mmol/L: Give IV calcium gluconate 10–20 mL of 10% solution over 1–5 minutes with ECG monitoring; its effect may be transient and repeat dosing may be needed. SmPC Potassium
Shift potassium intracellularly: Give 10–25% glucose 300–500 mL/hour with up to 10 units of insulin for each 20 g glucose, or give sodium bicarbonate infusion. SmPC Potassium
Remove potassium: Sodium polystyrene sulphonate may be used for mild hyperkalaemia, and haemodialysis or peritoneal dialysis may be required if initial measures fail. SmPC Potassium
Monitoring: Recheck potassium every 2–3 hours while raised, use continuous 12-lead ECG monitoring, and observe asymptomatic patients for at least 6 hours. SmPC Potassium