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Management of hyperkalemia in children

Michael J Somers, MD
Section Editor
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD


Hyperkalemia is typically defined as a serum or plasma potassium greater than 5.5 mEq/L (mmol/L). However, the upper limit of normal in preterm infants and young infants may be as high as 6.5 mEq/L (mmol/L). Although children are less likely to develop hyperkalemia than adults, pediatric hyperkalemia is not an uncommon occurrence. Severe hyperkalemia (potassium level ≥7 mEq/L [mmol/L]) is a serious medical problem that requires immediate attention.

The management of hyperkalemia in children is reviewed here. The etiology, clinical findings, diagnosis, and evaluation of pediatric hyperkalemia are presented separately. (See "Causes, clinical manifestations, diagnosis, and evaluation of hyperkalemia in children".)


The urgency of treatment of hyperkalemia varies with the level of extracellular (serum/plasma) potassium, the rapidity of the increase in potassium, and the presence of associated hyperkalemic-symptoms (algorithm 1).

The urgency and type of therapy are similar to that used in adults and are based on the severity of hyperkalemia and its potential to be life-threatening. (See "Treatment and prevention of hyperkalemia in adults", section on 'Determining the urgency of therapy'.)

Initial emergent therapy is directed towards the patients who are at risk for life-threatening cardiac conduction disturbances due to hyperkalemia (table 1 and figure 1). The onset of action of emergent interventions is immediate (see "Causes, clinical manifestations, diagnosis, and evaluation of hyperkalemia in children", section on 'Cardiac conduction abnormalities' and 'Rapid measures to counteract adverse cardiac effects' below):

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Literature review current through: Nov 2017. | This topic last updated: Jan 12, 2017.
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