Hyperkalemia causes: Difference between revisions

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| <figure-inline>[[File:Siren.gif|link=hyperkalemia resident survival guide|41x41px]]</figure-inline>|| <br> || <br>
| [[Hyperkalemia resident survival guide|Resident <br> Survival  <br> Guide]]
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{{Hyperkalemia}}
{{Hyperkalemia}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh@perfuse.org]
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{RT}}, {{MS}}
 
==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]] is an elevated [[blood]] level (above 5.1 mmol/L) of the [[electrolyte]] [[potassium]]. ". Extreme degrees of [[hyperkalemia]] are considered a [[medical emergency]] due to the risk of potentially fatal [[arrhythmia]]s. Hyperkalemia can be caused by reasons that include increased uptake, [[extracellular]] shift, tissue breakdown and impaired excretion from the [[body]].
==Causes==


===Complete Differential Diagnosis of the Causes of Hyperkalemia===
===Life Threatening Causes===
(By organ system)
*Hyperkalemia can become a life-threatening condition if potassium levels are too high and body is not able to remove it effectively.
{|style="width:80%; height:100px" border="1"
*[[Acute kidney injury|AKI]] and [[chronic renal failure]]<ref name="pmid11095656">{{cite journal| author=De Nicola L, Bellizzi V, Minutolo R, Cioffi M, Giannattasio P, Terracciano V et al.| title=Effect of dialysate sodium concentration on interdialytic increase of potassium. | journal=J Am Soc Nephrol | year= 2000 | volume= 11 | issue= 12 | pages= 2337-43 | pmid=11095656 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11095656  }} </ref>
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
*[[Addisonian crisis]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Heart failure]], [[Volume depletion]]
*[[Diabetic ketoacidosis]]
*Intravenous [[potassium]] supplement
*[[Digoxin]] toxicity
*[[Tumor lysis syndrome]]
 
===Common Causes===
The most common causes of hyperkalemia include:<ref name="pmid18839206">{{cite journal| author=Wang WH, Giebisch G| title=Regulation of potassium (K) handling in the renal collecting duct. | journal=Pflugers Arch | year= 2009 | volume= 458 | issue= 1 | pages= 157-68 | pmid=18839206 | doi=10.1007/s00424-008-0593-3 | pmc=2730119 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18839206  }} </ref><ref name="pmid21170894">{{cite journal| author=Giebisch GH, Wang WH| title=Potassium transport--an update. | journal=J Nephrol | year= 2010 | volume= 23 Suppl 16 | issue=  | pages= S97-104 | pmid=21170894 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21170894  }} </ref>
* [[ACE inhibitors]]
* [[Acidosis]]
* [[Addisonian crisis]]
* [[Beta blockers]]
* [[Blood transfusion]]
* [[Cirrhosis]]
* [[Diabetic nephropathy]]
* [[Potassium#Potassium in The Diet|High potassium diet]]
* [[Malnutrition]]
* [[Renal tubular acidosis]]
 
=== Less common causes ===
* Fasting
*[[Exercise]]
*[[Fluoride]] toxicity
*[[Hypoparathyroidism]]
 
=== Genetic causes ===
*[[Congenital adrenal hyperplasia|Congenital adrenal hypoplasia]]
* Hyperkalemic periodic paralysis
*[[Pseudohypoaldosteronism]] type1 and type 2
 
===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | [[Heart failure]], [[volume depletion]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Ammonium Bifluoride]], [[Arsenicals]], [[Fluoride]] toxicity, [[Foxglove]] [[Poisoning]], [[Oleander]] [[Poisoning]], [[Tungsten]], [[White Chameleon]] [[Poisoning]]
| bgcolor="Beige" | [[Ammonium Bifluoride]], [[arsenicals]], [[fluoride]] toxicity, [[foxglove]] [[poisoning]], [[oleander]] [[poisoning]], [[tungsten]], white chameleon [[poisoning]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''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="Beige" | [[ACE inhibitors]], [[Acetaminophen and Oxycodone]], [[acetylsalicylic Acid]], [[aldosterone antagonists]], [[amiloride]], [[Amlodipine besylate and Valsartan]], [[angiotensin receptor blockers]], [[Basiliximab]], [[beta blockers]], [[Cefepime]], [[Cefpodoxime]], [[celecoxib]], [[Cidofovir]], [[cyclosporine]], [[diazoxide]], [[digoxin]], [[Drospirenone and Ethinyl estradiol]], [[eplerenone]], epsilon amino caproic acid, (EACA), [[erythropoietin]], [[heparin]], [[ibuprofen]], [[indomethacin]], [[isoflurane]], [[ketoprofen]], [[low-molecular weight heparin]], [[Lisinopril and Hydrochlorothiazide]], [[mannitol]], [[melarsoprol]], [[methotrexate]], [[minoxidil]], [[naproxen]], [[Nivolumab]], [[Nilotinib]], [[pancuronium bromide]], [[pimecrolimus]], [[potassium chloride]], [[Potassium bicarbonate]], [[potassium citrate]], [[pomalidomide]],[[propofol infusion syndrome]], [[rifaximin]], [[sodium thiopental]], [[somatostatin]] therapy, [[spironolactone]], [[succinylcholine]], [[sulindac]], [[suxamethonium]], [[tacrolimus]], [[thalidomide]], [[triamterene]], [[trimethoprim]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''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="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"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Cirrhosis]], [[Gastrointestinal bleeding]]
| bgcolor="Beige" | [[Cirrhosis]], [[gastrointestinal bleeding]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| [[18-Hydroxylase deficiency]], [[Congenital adrenal hyperplasial]] type 3, [[Congenital adrenal hyperplasia]] -- sodium-wasting form, [[Isolated aldosterone synthase deficiency]], [[Lipoid congenital adrenal hyperplasia]], [[Pseudohypoaldosteronism]] type 1, autosomal dominant, [[Pseudohypoaldosteronism]] type 1, autosomal recessive, [[Pseudohypoaldosteronism]] type II
| 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"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| [[Hemolytic anemia]], [[Leukaemia]], [[Leukocytosis]], [[Sickle cell disease]], [[Thrombotic thrombocytopenic purpura]], congenital
| bgcolor="Beige" | [[Hemolytic anemia]], [[leukaemia]], [[leukocytosis]], [[sickle cell disease]], [[thrombotic thrombocytopenic purpura]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''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="Beige" |  [[blood transfusion ]] , 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"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[HIV infection]]
| bgcolor="Beige" | [[HIV]] infection
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Muscle damage]], [[Muscle wasting]]
| bgcolor="Beige" | Muscle damage, muscle wasting
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| [[Amelo-cerebro-hypohidrotic syndrome]], [[Kohlschutter-Tonz syndrome]]
| bgcolor="Beige" | [[Amelo-cerebro-hypohidrotic syndrome]], Kohlschutter-Tonz syndrome
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Arginine hydrochloride]], [[Increased ingestion of high potassium foods]], [[Increased ingestion of potassium containing drugs]], [[Malnutrition]]
| bgcolor="Beige" | [[Arginine|hydrochloride Arginine]], high [[Potassium]] diet, [[Malnutrition]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''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]], [[Pseudohyperkalaemia, familial, due to red cell leak]], Distal [[Renal tubular acidosis]] type 1, [[Transplanted kidneys]], [[Tubulointerstitial disease]], [[Urinary tract obstruction]], [[Urolithiasis]], [[Hyporeninemic hypoaldosteronism]], [[Amyloidosis]] - Renal
| 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]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Systemic lupus erythematosus]], [[Autoimmune adrenalitis]]
| bgcolor="Beige" | [[systemic lupus erythematosus]], [[autoimmune adrenalitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| [[Crush syndrome]]
| bgcolor="Beige" | [[crush syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''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]]
| 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
|-
|-
|}
|}


=== Ineffective elimination from the body===
===Causes in Alphabetical Order===
* [[Renal insufficiency]]
* [[Medication]] that interferes with urinary excretion:
** [[ACE inhibitor]]s and [[angiotensin II receptor antagonist|angiotensin receptor blockers]]
** Potassium-sparing [[diuretic]]s (e.g. [[amiloride]] and [[spironolactone]])
** [[Non-steroidal anti-inflammatory drugs|NSAIDs]] such as [[ibuprofen]], [[naproxen]], or [[Celebrex|celecoxib]]
** The [[Immunosuppressive drug#Drugs acting on immunophilins|calcineurin inhibitor]] immunosuppressants [[ciclosporin]] and [[Prograf|tacrolimus]]
** The antibiotic [[trimethoprim]]
** The antiparasitic drug [[pentamidine]]
* [[Mineralocorticoid]] deficiency or resistance, such as:
** [[Addison's disease]]
** [[Hypoaldosteronism|Aldosterone deficiency]], including reduced levels due to the blood thinner, [[heparin]]
** Some forms of [[congenital adrenal hyperplasia]]
** Type IV [[renal tubular acidosis]] (resistance of renal tubules to aldosterone)
* Gordon's syndrome (“familial hypertension with hyperkalemia”), a rare genetic disorder caused by defective modulators of salt transporters, including the [[thiazide-sensitive Na-Cl cotransporter]].
 
=== Excessive release from cells===
* [[Rhabdomyolysis]], [[burn (injury)|burns]] or any cause of rapid tissue [[necrosis]], including [[tumor lysis syndrome]]
* Massive [[blood transfusion]] or massive [[hemolysis]]
* Shifts/transport out of cells caused by [[acidosis]], low [[insulin]] levels, [[beta-blocker]] therapy, [[digoxin]] overdose, or the paralyzing anesthetic [[succinylcholine]]
 
=== Excessive intake===
* [[Intoxication]] with salt-substitute, potassium-containing dietary supplements, or potassium-chloride ([[KCl]]) infusion.  Note that for a person with normal kidney function and nothing interfering with normal elimination (see above), hyperkalemia by potassium intoxication would be seen only with large infusions of KCl or massive doses of oral KCl supplements.


===Lethal injection===
{{MultiCol|width:80%}}
Hyperkalemia is intentionally brought about in an execution by lethal injection, [[potassium chloride]] being the third and last of the three drugs generally administered to cause death, after [[sodium thiopental]] has rendered the subject unconscious, then [[pancuronium bromide]] has been added to cause respiratory collapse.
* [[Acidosis]]
 
* [[ACTH Deficiency]]
===Pseudohyperkalemia===
* [[Acute glomerulonephritis]]
Pseudohyperkalemia is a rise in the amount of potassium that occurs due to excessive leakage of potassium from cells, during or after blood is drawn.  It is a laboratory artifact rather than a biological abnormality and can be misleading to doctors.<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> Pseudohyperkalemia is typically caused by [[hemolysis]] during [[venipuncture]] (by either excessive vacuum of the blood draw or by a syringe needle that is of too fine a gauge); excessive tournequet time or fist clenching during phlebotomy (which presumably leads to efflux of potassium from the muscle cells into the bloodstream).<ref>Don BR et al. (1990) Pseudohyperkalemia caused by fist clenching during phlebotomy. N Engl J Med, 322(18):1290-2; PMID 2325722.</ref>; or by a delay in the processing of the blood specimen.  It can also occur in specimens from patients with abnormally high numbers of [[platelet]]s (>1,000,000/mm³), [[leukocyte]]s (> 100 000/mm³), or [[erythrocyte]]s (hematocrit > 55%). People with "leakier" [[cell membrane]]s have been found, whose blood must be separated immediately to avoid pseudohyperkalemia.<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>
* [[Acute renal failure]]
* [[Addisonian crisis]]
* [[Addison's disease]]
* [[Adrenal gland disorders]]
* [[Congenital adrenal hyperplasia due to 21-hydroxylase deficiency]]
* [[Aldosterone antagonists]]
* [[Amelo-cerebro-hypohidrotic syndrome]]
* [[Amiloride]]
* [[Ammonium Bifluoride]]
* [[Amyloidosis]]
* [[Angiotensin receptor blockers]]
* [[Arginine hydrochloride]]
* [[Arsenicals]]
* [[Autoimmune adrenalitis]]
* [[Beta blockers]]
* [[Blood transfusion]]
* [[Burns]]
* [[Celecoxib]]
*[[Cefepime]]
* [[Interstitial nephritis]]
* [[Chronic renal failure]]
*[[Cidofovir]]
* [[Cirrhosis]]
* [[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
{{ColBreak}}
* [[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]]
* [[Indomethacin]]
* [[Internal bleeding]]
* [[Intravenous infusion]]
* [[Isoflurane]]
* Isolated aldosterone synthase deficiency
* IV fluids containing [[Potassium]]
* [[Ketoprofen]]
* Kohlschutter-Tonz syndrome
* [[Leukaemia]]
* [[Leukocytosis]]
* [[Lipoid congenital adrenal hyperplasia]]
* [[Lisinopril and Hydrochlorothiazide]]
* [[Low-molecular weight heparin]]
* [[Lupus nephritis]]
* [[Malignant hyperpyrexia]]
* [[Malnutrition]]
* [[Mannitol]]
* [[Melarsoprol]]
* [[Methotrexate]]
* [[Minoxidil]]
* Muscle damage
* [[Muscle wasting]]
* [[Naproxen]]
* [[Obstructive uropathy]]
{{ColBreak}}
* [[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]]
* [[Pseudohyperkalemia]] 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]]
* [[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}}


==References==
==References==
<references />
{{Reflist|2}}


[[Category:Potassium]]
[[Category:Potassium]]
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Needs overview]]
{{WH}}
{{WS}}

Latest revision as of 23:11, 29 April 2020

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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]; Raviteja Guddeti, M.B.B.S. [3], Mahmoud Sakr, M.D. [4]

Overview

Hyperkalemia is an elevated blood level (above 5.1 mmol/L) of the electrolyte potassium. ". Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias. Hyperkalemia can be caused by reasons that include increased uptake, extracellular shift, tissue breakdown and impaired excretion from the body.

Causes

Life Threatening Causes

Common Causes

The most common causes of hyperkalemia include:[2][3]

Less common causes

Genetic causes

Causes by Organ System

Cardiovascular Heart failure, volume depletion
Chemical / poisoning Ammonium Bifluoride, arsenicals, fluoride toxicity, foxglove poisoning, oleander poisoning, tungsten, white chameleon poisoning
Dermatologic No underlying causes
Drug Side Effect ACE inhibitors, Acetaminophen and Oxycodone, acetylsalicylic Acid, aldosterone antagonists, amiloride, Amlodipine besylate and Valsartan, angiotensin receptor blockers, Basiliximab, beta blockers, Cefepime, Cefpodoxime, celecoxib, Cidofovir, cyclosporine, diazoxide, digoxin, Drospirenone and Ethinyl estradiol, eplerenone, epsilon amino caproic acid, (EACA), erythropoietin, heparin, ibuprofen, indomethacin, isoflurane, ketoprofen, low-molecular weight heparin, Lisinopril and Hydrochlorothiazide, mannitol, melarsoprol, methotrexate, minoxidil, naproxen, Nivolumab, Nilotinib, pancuronium bromide, pimecrolimus, potassium chloride, Potassium bicarbonate, potassium citrate, pomalidomide,propofol infusion syndrome, rifaximin, sodium thiopental, somatostatin therapy, spironolactone, succinylcholine, sulindac, suxamethonium, tacrolimus, thalidomide, triamterene, trimethoprim
Ear Nose Throat No underlying causes
Endocrine 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
Environmental No underlying causes
Gastroenterologic Cirrhosis, gastrointestinal bleeding
Genetic 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
Hematologic Hemolytic anemia, leukaemia, leukocytosis, sickle cell disease, thrombotic thrombocytopenic purpura
Iatrogenic blood transfusion , 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
Infectious Disease HIV infection
Musculoskeletal / Ortho Muscle damage, muscle wasting
Neurologic Amelo-cerebro-hypohidrotic syndrome, Kohlschutter-Tonz syndrome
Nutritional / Metabolic hydrochloride Arginine, high Potassium diet, Malnutrition
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte 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
Rheum / Immune / Allergy systemic lupus erythematosus, autoimmune adrenalitis
Sexual No underlying causes
Trauma crush syndrome
Urologic No underlying causes
Dental No underlying causes
Miscellaneous 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


References

  1. ↑ De Nicola L, Bellizzi V, Minutolo R, Cioffi M, Giannattasio P, Terracciano V; et al. (2000). "Effect of dialysate sodium concentration on interdialytic increase of potassium". J Am Soc Nephrol. 11 (12): 2337–43. PMID 11095656.
  2. ↑ Wang WH, Giebisch G (2009). "Regulation of potassium (K) handling in the renal collecting duct". Pflugers Arch. 458 (1): 157–68. doi:10.1007/s00424-008-0593-3. PMC 2730119. PMID 18839206.
  3. ↑ Giebisch GH, Wang WH (2010). "Potassium transport--an update". J Nephrol. 23 Suppl 16: S97–104. PMID 21170894.
  4. ↑ Sevastos N et al. (2006) Pseudohyperkalemia in serum: the phenomenon and its clinical magnitude. J Lab Clin Med, 147(3):139-44; PMID 16503244.
  5. ↑ Don BR et al. (1990) Pseudohyperkalemia caused by fist clenching during phlebotomy. N Engl J Med, 322(18):1290-2; PMID 2325722.
  6. ↑ Iolascon A et al. (1999) Familial pseudohyperkalemia maps to the same locus as dehydrated hereditary stomatocytosis. Blood, 93(9):3120-3; PMID 10216110.

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