Derangements of potassium

Emerg Med Clin North Am. 2014 May;32(2):329-47. doi: 10.1016/j.emc.2013.12.005. Epub 2014 Feb 28.


Changes in potassium elimination, primarily due to the renal and GI systems, and shifting potassium between the intracellular and extracellular spaces cause potassium derangement. Symptoms are vague, but can be cardiac, musculoskeletal, or gastrointestinal. There are no absolute guidelines for when to treat, but it is generally recommended when the patient is symptomatic or has ECG changes. Treatment of hyperkalemia includes cardiac membrane stabilization with IV calcium, insulin and beta-antagonists to push potassium intracellularly, and dialysis. Neither sodium bicarbonate nor kayexelate are recommended. Treatment of symptomatic hypokalemia consists of PO or IV repletion with potassium chloride and magnesium sulfate.

Keywords: Hyperkalemia; Hypokalemia; Peaked T waves; Potassium.

Publication types

  • Review

MeSH terms

  • Electrocardiography
  • Heart Arrest / etiology*
  • Heart Arrest / metabolism
  • Humans
  • Hyperkalemia / complications
  • Hyperkalemia / drug therapy
  • Hyperkalemia / metabolism*
  • Hypokalemia / complications
  • Hypokalemia / drug therapy
  • Hypokalemia / metabolism*
  • Myocardium / metabolism
  • Potassium / metabolism*
  • Potassium Chloride / therapeutic use
  • Risk Factors


  • Potassium Chloride
  • Potassium