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 conduction disturbances or neuromuscular dysfunction; if symptomatic, 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 in consultation with a specialist if appropriate.
• 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, to detect any progression or resolution.
• Provide patient education on avoiding high potassium intake if appropriate, especially if renal function is impaired.
• 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 if the patient is asymptomatic and stable, with careful monitoring and addressing reversible causes to prevent progression to more severe hyperkalaemia and associated complications ¹.