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| [[Hyperkalemia resident survival guide|Resident <br> Survival   <br> Guide]]
| [[Hyperkalemia resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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'''For patient information, click [[Hyperkalemia (patient information)|here]]'''
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{{Patient}}
{{Hyperkalemia}}
{{Hyperkalemia}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{RT}}
{{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; [[Jogeet Singh Sekhon]]
 
{{SK}} Hyperkalaemia.


==[[Hyperkalemia overview|Overview]]==
==[[Hyperkalemia overview|Overview]]==
''Hyperkalemia'' (AE) or ''Hyperkalaemia'' (BE) is an elevated blood level (above 5.0 mmol/L) of the [[electrolyte]] [[potassium]]. The prefix ''hyper-'' means high (contrast with ''hypo-'', meaning low).  The middle ''kal'' refers to ''kalium'', which is [[Latin]] for potassium.  The end portion of the word, ''-emia'', means "in the blood". Extreme degrees of hyperkalemia are considered a [[medical emergency]] due to the risk of potentially fatal [[arrhythmia]]s
==[[Hyperkalemia pathophysiology|Pathophysiology]]==
Potassium is the most abundant [[intracellular]] [[cation]].  It is critically important for many physiologic processes, including maintenance of cellular [[membrane potential]], [[homeostasis]] of cell volume, and transmission of [[action potential]]s in [[nerve cell]]s. Its main dietary sources are vegetables (tomato and potato), fruits (orange and banana) and meat. Elimination is through the [[gastrointestinal tract]] and the [[kidney]].


The renal elimination of potassium is passive (through the [[glomeruli]]), and resorption is active in the [[proximal tubule]] and the ascending limb of the [[loop of Henle]]. There is active excretion of potassium in the [[distal tubule]] and the [[collecting duct]]; both are controlled by [[aldosterone]].
==[[Hyperkalemia historical perspective|Historical Perspective]]==


Hyperkalemia develops when there is excessive production (oral intake, tissue breakdown) or ineffective elimination of potassium. Ineffective elimination can be hormonal (in[[aldosterone]] deficiency) or due to causes in the renal parenchyma that impair excretion.
==[[Hyperkalemia classification|Classification]]==


Increased extracellular potassium levels result in [[depolarization]] of the membrane potentials of cells.  This depolarization opens some [[sodium channel|voltage-gated sodium channel]]s, but not enough to generate an action potential. After a short while, the open sodium channels inactivate and become [[refractory period|refractory]], increasing the threshold to generate an action potential. This leads to the impairment of neuromuscular, [[cardiac]], and [[gastrointestinal]] organ systems.  Of most concern is the impairment of cardiac conduction which can result in [[ventricular fibrillation]] or [[asystole]].
==[[Hyperkalemia pathophysiology|Pathophysiology]]==


Patients with the rare hereditary condition of [[hyperkalemic periodic paralysis]] appear to have a heightened sensitivity of muscular symptoms that are associated with transient elevation of potassium levels.  Episodes of muscle weakness and spasms can be precipitated by exercise or fasting in these subjects.==[[Hyperkalemia  
==[[Hyperkalemia causes|Causes]]==
==[[risk factors|Risk factors]]
==Risk Factors==
The kidneys normally remove excess potassium from the body. Most cases of [[hyperkalemia]] are caused by disorders that reduce the kidneys' ability to get rid of potassium. This may result from disorders such as:


* [[Acute kidney failure]]
==[[Hyperkalemia differential diagnosis|Differentiating Hyperkalemia from other Diseases]]==
* [[Chronic kidney failure]]
* [[Glomerulonephritis]]
* Obstructive uropathy
* Rejection of a [[kidney transplant]]


The hormone [[aldosterone]] regulates kidney removal of sodium and potassium. Lack of aldosterone can result in hyperkalemia with an increase in total body potassium.[[Addison's]] disease is one disorder that causes reduced aldosterone production.
==[[Hyperkalemia epidemiology and demographics|Epidemiology and Demographics]]==


Any time potassium is released from the cells, it may build up in the fluid outside the cells and in the bloodstream. Acidosis leads to the movement of potassium from inside the cells to the fluid outside the cells. Tissue injury can cause the cells to release potassium. Such injury includes:
==[[Hyperkalemia risk factors|Risk Factors]]==


* [[Burns]]
==[[Hyperkalemia screening|Screening]]==
* Disorders that cause blood cells to burst ([[hemolytic conditions]])
* Gastrointestinal [[bleeding]]
* [[Rhabdomyolysis]] from drugs, alcoholism, coma, or certain infections
* Surgery
* Traumatic injury
* Tumors


If the kidney is working properly, and there is enough aldosterone, tissue trauma alone rarely leads to hyperkalemia. A normally functioning kidney will remove the excess potassium that has been released from the cells.
==[[Hyperkalemia natural history, complications, and prognosis|Natural history, Complications and Prognosis]]==


Increased intake of potassium can cause hyperkalemia if kidney function is poor. Salt substitutes often contain potassium, as do many "low-salt" packaged foods.
==Diagnosis==
[[Hyperkalemia diagnostic study of choice|Diagnostic study of choice]] | [[Hyperkalemia history and symptoms|History and Symptoms]] | [[Hyperkalemia physical examination|Physical Examination]] | [[Hyperkalemia laboratory findings|Laboratory Findings]] | [[Hyperkalemia electrocardiogram|Electrocardiogram]] | [[Hyperkalemia x ray|X-Ray Findings]] | [[Hyperkalemia echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Hyperkalemia CT scan|CT-Scan Findings]] | [[Hyperkalemia MRI|MRI Findings]] | [[Hyperkalemia other imaging findings|Other Imaging Findings]] | [[Hyperkalemia other diagnostic studies|Other Diagnostic Studies]]


Hyperkalemia may be caused by medications, including medications that affect kidney function (potassium sparing diuretics, such as [[spironolactone]], [[amiloride]], or[[triamterene]]) and potassium supplements (especially intravenous potassium).
==Treatment==
==[[causes|Causes]]==
[[Hyperkalemia medical therapy|Medical Therapy]] | [[Hyperkalemia surgery|Surgery]] | [[Hyperkalemia primary prevention|Primary Prevention]] | [[Hyperkalemia secondary prevention|Secondary Prevention]] | [[Hyperkalemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hyperkalemia future or investigational therapies|Future or Investigational Therapies]]
===Common Causes===
* [[ACE inhibitors]]
* [[Acidosis]]
* [[Addisonian crisis]]
* [[Beta blockers]]
* [[Blood transfusion]] and complications
* [[Cirrhosis]]
* [[Diabetic nephropathy]]
* [[Increased ingestion of high potassium foods]]
* [[Malnutrition]]
* [[Renal tubular acidosis]]
* [[Renal failure]]


===Causes by Organ System===
==Case Studies==
{|style="width:80%; height:100px" border="1"
[[Hyperkalemia case study one|Case #1]]
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
{{WikiDoc Help Menu}}
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Heart failure]], [[Volume depletion]]
{{WikiDoc Sources}}
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Ammonium Bifluoride]], [[Arsenicals]], [[Fluoride]] toxicity, [[Foxglove]] [[Poisoning]], [[Oleander]] [[Poisoning]], [[Tungsten]], [[White Chameleon]][[Poisoning]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[ACE inhibitors]], [[Acetylsalicylic Acid]], [[Aldosterone antagonists]], [[Amiloride]], [[Angiotensin receptor blockers]], [[Beta blockers]],[[Celecoxib]], [[Cyclosporine]], [[Diazoxide]], [[Digoxin]], [[Eplerenone]], [[Epsilon amino caproic acid]] ([[EACA]]), [[Erythropoietin]], [[Heparin]], [[Ibuprofen]],[[Indomethacin]], [[Isoflurane]], [[Ketoprofen]], [[Low-molecular weight heparin]], [[Mannitol]], [[Melarsoprol]], [[Methotrexate]], [[Minoxidil]], [[Naproxen]],[[Pancuronium bromide]], [[Pimecrolimus]], [[Potassium chloride]], [[Potassium citrate]], [[Propofol infusion syndrome]], [[Sodium thiopental]], [[Somatostatin]] therapy,[[Spironolactone]], [[Succinylcholine]], [[Suxamethonium]], [[Tacrolimus]], [[Triamterene]], [[Trimethoprim]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[ACTH Deficiency]], [[Addisonian crisis]], [[Addison's disease]], [[Adrenal gland disorders]], [[Adrenal hyperplasia, congenital type 3]], [[Autoimmune adrenalitis]], [[Congenital adrenal hyperplasia]] -- sodium-wasting form, [[Diabetes]], [[Diabetic ketoacidosis]], [[Hyperglycemia]], Hypoadrenocorticism --[[hypoparathyroidism]] -- [[moniliasis]], [[Hyporeninemic hypoaldosteronism]], [[Isolated aldosterone synthase deficiency]], [[Lipoid congenital adrenal hyperplasia]],[[Pseudohypoaldosteronism]] type 1, [[Pseudohypoaldosteronism]] type 2
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Cirrhosis]], [[Gastrointestinal bleeding]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[18-Hydroxylase deficiency]], [[Congenital adrenal hyperplasia]] type 3, [[Congenital adrenal hyperplasia]] -- sodium-wasting form, [[Isolated aldosterone synthase deficiency]], [[Lipoid congenital adrenal hyperplasia]], [[Pseudohypoaldosteronism]] type 1, [[Pseudohypoaldosteronism]] type 2
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Hemolytic anemia]], [[Leukaemia]], [[Leukocytosis]], [[Sickle cell disease]], [[Thrombotic thrombocytopenic purpura]], congenital
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|  [[Oxalate blood sample]],  [[Blood transfusion and complications]], [[Cuffed blood sample]], [[Delayed separation blood sample]], [[Drip arm sample]],[[EDTA blood sample]], [[Hemolysed blood sample]], [[IV fluids containing potassium]], [[Using clenched fist while  collection of blood]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[HIV infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Muscle damage]], [[Muscle wasting]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Amelo-cerebro-hypohidrotic syndrome]], [[Kohlschutter-Tonz syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Arginine hydrochloride]], Increased ingestion of high [[Potassium]] foods, Increased ingestion of [[Potassium]] containing drugs, [[Malnutrition]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Acidosis]], [[Acute glomerulonephritis]], [[Acute renal failure]], Chronic [[Interstitial nephritis]], [[Chronic renal failure]], [[Diabetic nephropathy]], [[Distal chloride shunt]], Distal [[renal tubular acidosis]] type IV, [[Gordon's syndrome]], [[Hemolytic uremic syndrome]], [[Hyperkalemic periodic paralysis]], Hyperkalemic [[Renal tubular acidosis]], [[Hypernatremia]], [[Hyperosmolality]], [[Hyperphosphataemia]], [[Lupus nephritis]], [[Obstructive uropathy]],[[Polycystic kidney disease]], Familial [[Pseudohyperkalemia]]-due to red cell leak, Distal [[Renal tubular acidosis]] type 1, [[Transplanted kidneys]], [[Tubulointerstitial disease]], [[Urinary tract obstruction]], [[Urolithiasis]], [[Hyporeninemic hypoaldosteronism]], [[Amyloidosis]] - Renal
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Systemic lupus erythematosus]], [[Autoimmune adrenalitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Crush syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Amyloidosis]] - Renal, [[Burns]], [[Dehydration]], [[Fasting]], [[Hypothermia]], [[Internal bleeding]], [[Intravenous infusion]], [[Malignant |hyperpyrexia]], [[Phlebotomy]] complication, [[Rhabdomyolysis]], [[Sea snake poisoning]], [[Selective impairment of potassium excretion]], [[Strenuous |exercise]],[[Transplant rejection]], [[Tumor lysis syndrome]], Ureterojejunostomy|}


===Causes in Alphabetical Order===
[[Category:Emergency medicine]]
{{MultiCol}}
[[Category:Nephrology]]
* [[Acidosis]]
[[Category:Laboratory tests]]
* [[ACTH Deficiency]]
* [[Acute glomerulonephritis]]
* [[Acute renal failure]]
* [[Addisonian crisis]]
* [[Addison's disease]]
* [[Adrenal gland disorders]]
* [[Adrenal hyperplasia]], congenital-type 3
* [[Aldosterone antagonists]]
* [[Amelo-cerebro-hypohidrotic syndrome]]
* [[Amiloride]]
* [[Ammonium Bifluoride]]
* [[Amyloidosis]] - Renal
* [[Angiotensin receptor blockers]]
* [[Arginine hydrochloride]]
* [[Arsenicals]]
* [[Autoimmune adrenalitis]]
* [[Beta blockers]]
* [[Blood transfusion and complications]]
* [[Burns]]
* [[Celecoxib]]
* [[Chronic interstitial nephritis]]
* [[Chronic renal failure]]
* [[Cirrhosis]]
* [[Congenital adrenal hyperplasia]] -- sodium-wasting form
* [[Crush syndrome]]
* [[Cuffed blood sample]]
* [[Cyclosporine]]
* [[Dehydration]]
* [[Delayed separation blood sample]]
* [[Diabetes]]
* [[Diabetic ketoacidosis]]
* [[Diabetic nephropathy]]
* [[Diazoxide]]
* [[Digoxin]]
* [[Distal chloride shunt]]
* [[Drip arm sample]]
* [[EDTA blood sample]]
* [[Eplerenone]]
* [[Epsilon amino caproic acid (EACA)]]
* [[Erythropoietin]]
* [[Fasting]]
* [[Fluoride toxicity]]
* [[Foxglove poisoning]]
* [[Gastrointestinal bleeding]]
* [[Gordon's syndrome]]
* [[Heart failure]]
* [[Hemolysed blood sample]]<ref>Sevastos N et al. (2006) Pseudohyperkalemia in serum: the phenomenon and its clinical magnitude. J Lab Clin Med, 147(3):139-44; PMID 16503244.</ref>
* [[Hemolytic anemia]]
* [[Hemolytic uremic syndrome]]
* [[Heparin]]
* [[HIV infection]]
* [[Hyperglycemia]]
* [[Hyperkalemic periodic paralysis]]
* Hyperkalemic [[Renal tubular acidosis]]
* [[Hypernatremia]]
* [[Hyperosmolality]]
* [[Hyperphosphataemia]]
* [[Hypoadrenocorticism]] -- [[hypoparathyroidism]] -- [[moniliasis]]
* [[Hyporeninemic hypoaldosteronism]]
* [[Hypothermia]]
* [[Ibuprofen]]
* [[Increased ingestion of high potassium foods]]
* [[Increased ingestion of potassium containing drugs]]
{{ColBreak}}
* [[Indomethacin]]
* [[Internal bleeding]]
* [[Intravenous infusion]]
* [[Isoflurane]]
* [[Isolated aldosterone synthase deficiency]]
* IV fluids containing [[Potassium]]
* [[Ketoprofen]]
* [[Kohlschutter-Tonz syndrome]]
* [[Leukaemia]]
* [[Leukocytosis]]
* [[Lipoid congenital adrenal hyperplasia]]
* [[Low-molecular weight heparin]]
* [[Lupus nephritis]]
* [[Malignant hyperpyrexia]]
* [[Malnutrition]]
* [[Mannitol]]
* [[Melarsoprol]]
* [[Methotrexate]]
* [[Minoxidil]]
* [[Muscle damage]]
* [[Muscle wasting]]
* [[Naproxen]]
* [[Obstructive uropathy]]
* [[Oleander]] [[Poisoning]]
* [[Oxalate blood sample]]
* [[Pancuronium bromide]]
* [[Phlebotomy]] complication<ref>Don BR et al. (1990) Pseudohyperkalemia caused by fist clenching during phlebotomy. N Engl J Med, 322(18):1290-2; PMID 2325722.</ref>
* [[Pimecrolimus]]
* [[Polycystic kidney disease]]
* [[Potassium chloride]]
* [[Potassium citrate]]
* [[Propofol infusion syndrome]]
* [[Pseudohyperkalaemia, familial, due to red cell leak]] <ref>Iolascon A et al. (1999) Familial pseudohyperkalemia maps to the same locus as dehydrated hereditary stomatocytosis. Blood, 93(9):3120-3; PMID 10216110.</ref>
* [[Pseudohypoaldosteronism]] type 1
* [[Pseudohypoaldosteronism]] type II
* [[Pyrimidifen]]
* [[Renal tubular acidosis]], distal-type 1
* [[Renal tubular acidosis]], distal-type 4
* [[Rhabdomyolysis]]
* [[Sea snake poisoning]]
* [[Selective impairment of potassium excretion]]
* [[Sickle cell disease]]
* [[Sodium thiopental]]
* [[Somatostatin]] therapy
* [[Spironolactone]]
* [[Strenuous exercise]]
* [[Succinylcholine]]
* [[Suxamethonium]]
* [[Systemic lupus erythematosus]]
* [[Tacrolimus]]
* [[Thrombotic thrombocytopenic purpura]]-congenital
* [[Thrombocytosis]]
* [[Transplant rejection]]
* [[Transplanted kidneys]]
* [[Triamterene]]
* [[Trimethoprim]]
* [[Tubulointerstitial disease]]
* [[Tumor lysis syndrome]]
* [[Tungsten]]
* [[Ureterojejunostomy]]
* [[Urinary tract obstruction]]
* [[Urolithiasis]]
* [[Using clenched fist while  collection of blood]]
* [[Volume depletion]]
* [[White Chameleon poisoning]]
{{EndMultiCol}}

Latest revision as of 22:15, 29 July 2020
Resident
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For patient information, click here.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]; Jogeet Singh Sekhon

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hyperkalemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural history, Complications and Prognosis

Diagnosis

Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

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Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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