An 80-year-old has K+ 7.2 on routine bloods. They feel mildly unwell. What is your approach?

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Severe hyperkalaemia is a medical emergency. ABCDE, immediate 12-lead ECG looking for peaked T waves, PR prolongation, wide QRS or sine wave. If ECG changes I would give 10ml 10% calcium gluconate IV over 10 minutes, repeated until ECG normalises, for cardioprotection. To shift potassium intracellularly I would give 10 units of Actrapid in 50ml of 50% dextrose over 15 minutes with hourly glucose monitoring, plus 10-20mg nebulised salbutamol. I would stop nephrotoxic and potassium-sparing drugs, send a repeat U&E, VBG and bone profile, review fluid status and consider IV fluids if dehydrated. I would identify the cause — AKI, drugs, rhabdomyolysis — and contact renal early for haemofiltration if refractory or anuric. Document and reassess every 30 minutes.

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