Hyperkalemia (Raised Potassium) Triage Questionnaire

Hyperkalemia, defined as elevated serum potassium levels exceeding 5.1 mmol/L (with some guidelines considering a threshold of 5.3 mmol/L or higher), is a significant clinical concern in primary care, particularly among patients with chronic kidney disease (CKD), heart failure, and those on renin-angiotensin-aldosterone system (RAAS) inhibitors. Its management is critical due to the associated risks of severe complications, including cardiac arrhythmias and increased mortality (Kövesdy, 2016; Bianchi et al., 2019). In primary care settings, hyperkalemia prevalence has been reported at approximately 5% to 6.3%, underscoring the need for vigilant monitoring and proactive management strategies (Sevamontree et al., 2024; Nicola et al., 2023).

Challenges in the outpatient management of hyperkalemia include ensuring the accuracy of potassium level measurements, addressing the potential for factitious hyperkalemia due to hemolysis, and implementing timely interventions (Chiu et al., 2023). Clinicians must be skilled in distinguishing between true hyperkalemia and falsely elevated readings to avoid unnecessary emergency referrals (Chiu et al., 2023). Management strategies are multifaceted, incorporating dietary modifications, pharmacological interventions such as potassium binders, and regular monitoring of serum potassium levels to effectively mitigate risks (Sarnowski et al., 2022; Son, 2024; AlSahow et al., 2024).

1. Confirmed Hyperkalemia?

Yes No

Why? Ensuring accurate lab results prevents unnecessary interventions.

2. Reported Potassium Level (mmol/L)?

< 5.9 (Mild) 6.0 - 6.4 (Moderate) ≥ 6.5 (Severe)

Why? Potassium levels ≥ 6.0 mmol/L increase risk of arrhythmias.

3. Reason for Test?

Routine screening Suspected electrolyte imbalance CKD follow-up Medication monitoring

Why? Helps contextualize results.

4. Symptoms?

No symptoms Muscle weakness Palpitations Shortness of breath

Why? Neuromuscular/cardiac symptoms need urgent care.

5. Recent ECG Findings?

Normal Peaked T waves Widened QRS

Why? ECG changes indicate cardiac instability.

6. Recent Medications?

ACE inhibitors ARBs NSAIDs

Why? These drugs impair potassium excretion.

7. Underlying Conditions?

CKD Heart failure

Why? CKD and heart failure affect potassium balance.

8. Dietary or Supplement Intake?

High potassium foods Potassium supplements

Why? Diet and supplements can worsen hyperkalemia.

9. Renal Function Status?

Normal CKD

Why? Impaired renal function reduces potassium excretion.

10. Pattern of Readings?

Single elevated reading Persistent elevation

Why? Helps distinguish transient from chronic cases.

11. Pseudohyperkalemia Considerations?

Possible hemolysis EDTA contamination Confirmed true hyperkalemia

Why? Prevents mismanagement due to lab errors.

12. Creatinine & eGFR?

Normal Elevated Creatinine / Reduced eGFR

Why? Renal impairment contributes to hyperkalemia.

The management of hyperkalemia in primary care is a complex but essential aspect of patient care that necessitates a comprehensive understanding of its etiology, implications, and treatment options. The causes can be broadly seen as

Cause Category	Specific Causes/Subcategories	Description/Mechanism
Renal Dysfunction	- Chronic Kidney Disease (CKD) - Acute Kidney Injury (AKI) - Congestive Heart Failure	Impaired renal excretion of potassium due to reduced glomerular filtration rate (GFR ↓). CKD and AKI hinder the kidneys’ ability to eliminate potassium, while heart failure may further exacerbate renal impairment.
Medication Effects	- RAAS inhibitors (ACEIs, ARBs) - Potassium-sparing diuretics (e.g., spironolactone) - NSAIDs - Certain antibiotics	These medications can decrease aldosterone activity or impair renal function, resulting in reduced potassium excretion and elevated serum potassium levels (↑).
Metabolic/Endocrine Disturbances	- Metabolic acidosis - Diabetic ketoacidosis - Adrenal insufficiency - Excessive potassium intake	Acidosis causes a shift of potassium from intracellular to extracellular spaces (↑). Endocrine disorders, such as adrenal insufficiency, decrease aldosterone production (↓), and high potassium intake can overwhelm excretion mechanisms.
Other Factors	- Tissue trauma/Hemolysis - Pseudohyperkalemia	Tissue injury or hemolysis releases intracellular potassium into the bloodstream (↑), while pseudohyperkalemia results from sample handling errors, leading to falsely elevated potassium readings.