Hyperkalemia is a common electrolyte disorder with potentially lethal consequences. Severe hyperkalemia can lead to life-threatening cardiac dysrhythmias, making a clear understanding of emergency management crucial. Recognition of patients at risk for cardiac arrhythmias should be followed by effective strategies for reduction in serum potassium levels. In the outpatient setting, diagnosis of hyperkalemia can be complicated by factitious elevations in serum potassium levels. True elevations in serum potassium levels are commonly due to medications used for cardiovascular disease in the setting of impaired glomerular filtration rate. The prevalence of chronic kidney disease is steadily increasing, likely leading to increases in risk of hyperkalemia. A systematic approach will aid in timely diagnosis and management of hyperkalemia.