Severe hyperkalemia
Unexpected severe hyperkalemia may represent a serious complication of hospitalization and can be encountered across inpatient departments of all medical specialties. The algorithm helps to systematize the recommendations of the ERC 2025 guidelines, which should guide the management of this potentially life-threatening condition. In addition to immediate symptomatic treatment, it is essential to actively search for the underlying cause. Without its identification and adequate management, the reduction of serum potassium levels remains only a temporary measure that may be insufficient in the long term.
Review
Severe hyperkalemia in both adults and children is among the potentially reversible causes of cardiac arrest. Early recognition and prompt initiation of appropriate treatment are essential to prevent progression to cardiac arrest. One of the less common causes of hyperkalemia is the administration of succinylcholine during tracheal intubation. The proposed algorithm provides a clear, concise, and educational overview of the recognition and management of hyperkalemia in accordance with current clinical practice guidelines. The management of hyperkalemia in pediatric patients is also briefly addressed in the concluding section. Overall, I consider this algorithm to be very well designed and clearly presented. It is didactically sound and fully consistent with current guideline recommendations.
Sources
LOTT, Carsten et al. European Resuscitation Council Guidelines 2025: Special circumstances in resuscitation. Resuscitation. 2025, roč. 215, suppl. 1, čl. 110753. ISSN 0300-9572. Available from: resuscitationjournal
GREIF, R. et al. European Resuscitation Council Guidelines 2025: Executive summary. Resuscitation. 2025. ISSN 0300-9572. Available from: researchgate
INTERNATIONAL LIAISON COMMITTEE ON RESUSCITATION. Consensus on Science with Treatment Recommendations (CoSTR) 2025. Circulation. 2025. ISSN 0009-7322. Available from: ahajournals
NOLAN, Jerry P. et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2025: Post-resuscitation care. Resuscitation. 2025. ISSN 0300-9572. Available from: studocu
ROYAL CORNWALL HOSPITALS NHS TRUST. Adult Hyperkalaemia Management Clinical Guideline. 2022. Available from: doclibrary-rcht.cornwall
Learning targets
2. The student masters the principles of treatment according to the new ERC 2025 recommendations.
3. The student is aware of risk situations (denervation, burns, neuromuscular disorders, long hospitalization) in which hyperkalemia may occur when using succinylcholine in the operating room.
Key points
2. The first line of causal treatment for severe hyperkalemia is the administration of 25 g of glucose with 10 units of fast-acting insulin i.v.
3. Large amounts of potassium are released from neurons extracellularly due to upregulation of presynaptic acetylcholine receptors.
