Potassium replacement for adults with hyperosmolar hyperglycaemia

The need for potassium replacement for adults with hyperosmolar hyperglycaemia depends on individual circumstances.

Patients with hyperosmolar hyperglycaemia are usually potassium depleted; however, they are less acidotic than patients with diabetic ketoacidosis (DKA) so potassium shifts are less pronounced, the dose of insulin needed is lower and there is often concurrent kidney impairment. Patients with impaired kidney function need a more conservative approach to potassium replacement—seek specialist advice.

Intravenous potassium replacement can be started when the serum potassium concentration is less than 5 mmol/L, kidney function is known and urinary output is adequate. The goal is to maintain serum potassium concentrations between 3.5 and 4.5 mmol/L. Careful replacement and frequent monitoring are required. Measure the serum potassium concentration hourly and adjust the potassium infusion rate according to local hospital protocol if available; otherwise, seek specialist advice.