How should I manage a patient with mild hyperkalaemia (potassium level 5.5-6.0 mmol/L) in primary care?

Management of mild hyperkalaemia (serum potassium 5.5 to 6.0 mmol/L) in primary care:

• Confirm the serum potassium level with a repeat test to exclude spurious hyperkalaemia.
• Assess for any symptoms or signs of cardiac arrhythmia or neuromuscular dysfunction; if present, urgent referral to secondary care is required.
• Review the patient’s medications, especially potassium-sparing diuretics, ACE inhibitors, ARBs, and aldosterone antagonists, as these increase the risk of hyperkalaemia. Consider stopping or adjusting these medications if clinically appropriate, in consultation with relevant specialists.
• Evaluate for underlying causes such as acute illness, renal impairment, or other conditions that may contribute to hyperkalaemia.
• Monitor serum potassium levels regularly, with the frequency based on clinical judgement and risk factors.
• Advise dietary potassium intake moderation if appropriate, but avoid abrupt dietary changes without specialist advice.
• Refer to secondary care if potassium levels rise above 6.0 mmol/L, if the patient is symptomatic, or if there is uncertainty about management.

Primary care management is appropriate for mild hyperkalaemia in asymptomatic patients without severe comorbidities or risk factors for poor outcomes, with careful monitoring and medication review to prevent progression and complications ¹,⁴.