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Background and Importance Management of acute hyperkalaemia requires specific measures including fast-acting therapies, potassium-excreting therapies, and adjustment of chronic medications. The Spanish Societies of Cardiology (SEC), Endocrinology and Nutrition (SEEN), Internal Medicine (SEMI), Emergency Medicine (SEMES) and nephrology (SEN) provides a consensus document on its management.Aim and Objectives To assess the adequacy of hyperkalaemia management according to the consensus of five Spanish medical societies, and to identify areas for improvement.Material and Methods Observational, retrospective study conducted in the Emergency Department (ED) of a tertiary hospital (January 2025).Inclusion Criteria: ED patients with hyperkalaemia (K>5,5 mmol/L). A simple random sample of ~50% of eligible cases was analysed.Exclusion Criteria: haemolysed sampleVariables: sex, age, serum potassium, hyperkalaemia manifestations (muscle weakness, electrocardiogram changes), acute kidney injury or gastrointestinal bleeding, comorbidities (heart failure, chronic kidney disease, diabetes), chronic drugs that may increase kalemia, time until resolution, in ED hyperkalaemia treatment. Classification of hyperkalaemia (mild, moderate and severe).Two pharmacists and one emergency physician retrospectively reviewed the treatments. Management was considered adequate when it complied with the consensus recommendations.Results Hyperkalaemia was detected in 142 patients, 73 were randomly selected and 17 of them were excluded. Of the 56 patients, 30 were women (53.6%). The median age was 83 years (IQR: 71.75-90).Median potassium level at admission: 5,8 mmol/L (IQR:5.6-6.4). Potassium >6,5 mmol/L:11/56 patients (19.6%).Classification: 37 severe (66.1%), 17 mild (30.3%), 2 moderate (3.6%).Manifestations: electrocardiographic abnormalities (5.4%), muscular weakness (1.8%), Comorbidities: chronic kidney failure (44.6%), heart failure (41.1%) diabetes (37.5%). acute kidney failure (32.1%), gastrointestinal bleeding (10.7%),Drugs: 44 patients had at least one active prescription of betablockers (35.7%), nonsteroidal anti-inflammatory drugs (32.1%), angiotensin II receptor antagonists (25.0%), aldosterone antagonists (21.1%) or ACE inhibitors (17.9%).Treatment: Severe hyperkalaemia were treated with rapid therapies that promote cellular potassium uptake (35.7%), antagonise potassium toxicity (16.1%), or enhance potassium elimination (sodium zirconium cyclosilicate 21.4%, calcium polystyrene sulfonate 12.5% diuretics 16.1%, haemodialysis 8.9%).Subsequent tests were performed in 38 (67.9%) patients, with potassium normalising on an average of 23.2 hours.Treatment adequacy: adequate in 43/56 (76.8%) and optimisable in 13/56 (23.2%).Conclusion and Relevance In this retrospective cohort, ED hyperkalaemia management deviated from consensus recommendations in about one quarter of cases, highlighting opportunities for hospital pharmacists to optimise treatment and reinforce protocol adherence.References and/or Acknowledgements 1. Consensus document on the management of hyperkalaemia. Nefrología, 2023;43(4):299–310. https://doi.org/10.1016/j.nefro.2023.05.004Conflict of Interest No conflict of interest