Life-threatening hyperkalemia in diabetics - An underestimated risk?

Diabetics are at a high risk of developing an acute hyperkalemia. Given a diabetic nephropathy, interactions of cardioactive drugs on the basis of an underlying acute deterioration of renal function are well known to cause this electrolyte disturbance. The diagnosis hyperkalemia cannot be confirmed preclinically. As life-threatening arrhythmia may occur and effective "antidotes" are available, it is important to screen for typical constellations in the preclinical setting. In case of a progressive cardiac decompensation and a strongly suspected hyperkalemia, pharmacological management (calcium chloride 10% i.v., nebulised beta-2 mimetics) may be life saving. Considering the differential diagnosis hyperkalemia during CPR delivery may also be relevant with respect to the possibly favourable outcome of this potentially reversible electrolyte disturbance.