Hyperkalemia causes: Difference between revisions

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{| class="infobox" style="float:right;"
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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===
==Most common==
*Hyperkalemia can become a life-threatening condition if potassium levels are too high and body is not able to remove it effectively.
*[[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>
*[[Addisonian crisis]]
*[[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]]
* [[ACE inhibitors]]
* [[Acidosis]]
* [[Acidosis]]
* [[Addisonian crisis]]
* [[Addisonian crisis]]
* [[Beta blockers]]
* [[Beta blockers]]
* [[Blood transfusion]] and complications
* [[Blood transfusion]]
* [[Cirrhosis]]
* [[Cirrhosis]]
* [[Diabetic nephropathy]]
* [[Diabetic nephropathy]]
* [[Increased ingestion of high potassium foods]]
* [[Potassium#Potassium in The Diet|High potassium diet]]
* [[Malnutrition]]
* [[Malnutrition]]
* [[Renal tubular acidosis]]
* [[Renal tubular acidosis]]
* [[Renal failure]]


==Organ system==
=== Less common causes ===
* Fasting
*[[Exercise]]
*[[Fluoride]] toxicity
*[[Hypoparathyroidism]]


{|style="width:80%; height:100px" border="1"
=== Genetic causes ===
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
*[[Congenital adrenal hyperplasia|Congenital adrenal hypoplasia]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Heart failure]], [[Volume depletion]]
* 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 hyperplasia]] type 3, [[Congenital adrenal hyperplasia]] -- sodium-wasting form, [[Isolated aldosterone synthase deficiency]], [[Lipoid congenital adrenal hyperplasia]], [[Pseudohypoaldosteronism]] type 1, [[Pseudohypoaldosteronism]] type 2
| 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]], 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="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
|-
|-
|}
|}


==Alphabetical order==
===Causes in Alphabetical Order===


{{MultiCol}}  
{{MultiCol|width:80%}}
* [[Acidosis]]
* [[Acidosis]]
* [[ACTH Deficiency]]
* [[ACTH Deficiency]]
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* [[Addison's disease]]
* [[Addison's disease]]
* [[Adrenal gland disorders]]
* [[Adrenal gland disorders]]
* [[Adrenal hyperplasia]], congenital-type 3
* [[Congenital adrenal hyperplasia due to 21-hydroxylase deficiency]]
* [[Aldosterone antagonists]]
* [[Aldosterone antagonists]]
* [[Amelo-cerebro-hypohidrotic syndrome]]
* [[Amelo-cerebro-hypohidrotic syndrome]]
* [[Amiloride]]
* [[Amiloride]]
* [[Ammonium Bifluoride]]
* [[Ammonium Bifluoride]]
* [[Amyloidosis]] - Renal
* [[Amyloidosis]]
* [[Angiotensin receptor blockers]]
* [[Angiotensin receptor blockers]]
* [[Arginine hydrochloride]]
* [[Arginine hydrochloride]]
Line 156: Line 181:
* [[Autoimmune adrenalitis]]
* [[Autoimmune adrenalitis]]
* [[Beta blockers]]
* [[Beta blockers]]
* [[Blood transfusion and complications]]
* [[Blood transfusion]]
* [[Burns]]
* [[Burns]]
* [[Celecoxib]]
* [[Celecoxib]]
* [[Chronic interstitial nephritis]]
*[[Cefepime]]
* [[Interstitial nephritis]]
* [[Chronic renal failure]]
* [[Chronic renal failure]]
*[[Cidofovir]]
* [[Cirrhosis]]
* [[Cirrhosis]]
* [[Congenital adrenal hyperplasia]] -- sodium-wasting form
* [[Crush syndrome]]
* [[Crush syndrome]]
* [[Cuffed blood sample]]
* Cuffed blood sample
* [[Cyclosporine]]
* [[Cyclosporine]]
* [[Dehydration]]
* [[Dehydration]]
* [[Delayed separation blood sample]]
* Delayed separation blood sample
* [[Diabetes]]
* [[Diabetes]]
* [[Diabetic ketoacidosis]]
* [[Diabetic ketoacidosis]]
Line 173: Line 199:
* [[Diazoxide]]
* [[Diazoxide]]
* [[Digoxin]]
* [[Digoxin]]
* [[Distal chloride shunt]]
* Distal [[chloride]] shunt
* [[Drip arm sample]]
* Drip arm sample
* [[EDTA blood sample]]
* EDTA blood sample
* [[Eplerenone]]
* [[Eplerenone]]
* [[Epsilon amino caproic acid (EACA)]]
* Epsilon amino caproic acid (EACA)
* [[Erythropoietin]]
* [[Erythropoietin]]
* [[Fasting]]
* [[Fasting]]
* [[Fluoride toxicity]]
* [[Fluoride]] toxicity
{{ColBreak}}
* [[Foxglove poisoning]]
* [[Foxglove poisoning]]
* [[Gastrointestinal bleeding]]
* [[Gastrointestinal bleeding]]
* [[Gordon's syndrome]]
* Gordon's syndrome
* [[Heart failure]]
* [[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>
* 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 anemia]]
* [[Hemolytic uremic syndrome]]
* [[Hemolytic uremic syndrome]]
Line 196: Line 223:
* [[Hyperosmolality]]
* [[Hyperosmolality]]
* [[Hyperphosphataemia]]
* [[Hyperphosphataemia]]
* [[Hypoadrenocorticism]] -- [[hypoparathyroidism]] -- [[moniliasis]]
* Hypoadrenocorticism-- [[hypoparathyroidism]] -- [[moniliasis]]
* [[Hyporeninemic hypoaldosteronism]]
* [[Hyporeninemic hypoaldosteronism]]
* [[Hypothermia]]
* [[Hypothermia]]
* [[Ibuprofen]]
* [[Ibuprofen]]
* [[Increased ingestion of high potassium foods]]
* [[Increased ingestion of potassium containing drugs]]
{{ColBreak}}
* [[Indomethacin]]
* [[Indomethacin]]
* [[Internal bleeding]]
* [[Internal bleeding]]
* [[Intravenous infusion]]
* [[Intravenous infusion]]
* [[Isoflurane]]
* [[Isoflurane]]
* [[Isolated aldosterone synthase deficiency]]
* Isolated aldosterone synthase deficiency
* IV fluids containing [[Potassium]]
* IV fluids containing [[Potassium]]
* [[Ketoprofen]]
* [[Ketoprofen]]
* [[Kohlschutter-Tonz syndrome]]
* Kohlschutter-Tonz syndrome
* [[Leukaemia]]
* [[Leukaemia]]
* [[Leukocytosis]]
* [[Leukocytosis]]
* [[Lipoid congenital adrenal hyperplasia]]
* [[Lipoid congenital adrenal hyperplasia]]
* [[Lisinopril and Hydrochlorothiazide]]
* [[Low-molecular weight heparin]]
* [[Low-molecular weight heparin]]
* [[Lupus nephritis]]
* [[Lupus nephritis]]
Line 222: Line 247:
* [[Methotrexate]]
* [[Methotrexate]]
* [[Minoxidil]]
* [[Minoxidil]]
* [[Muscle damage]]
* Muscle damage
* [[Muscle wasting]]
* [[Muscle wasting]]
* [[Naproxen]]
* [[Naproxen]]
* [[Obstructive uropathy]]
* [[Obstructive uropathy]]
{{ColBreak}}
* [[Oleander]] [[Poisoning]]
* [[Oleander]] [[Poisoning]]
* [[Oxalate blood sample]]
* Oxalate blood sample
* [[Pancuronium bromide]]
* [[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>
* [[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>
Line 235: Line 261:
* [[Potassium citrate]]
* [[Potassium citrate]]
* [[Propofol infusion syndrome]]
* [[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>  
* [[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 1
* [[Pseudohypoaldosteronism]] type II
* [[Pseudohypoaldosteronism]] type II
* [[Pyrimidifen]]
* Pyrimidifen
* [[Renal tubular acidosis]], distal-type 1
* [[Renal tubular acidosis]], distal-type 1
* [[Renal tubular acidosis]], distal-type 4
* [[Renal tubular acidosis]], distal-type 4
* [[Rhabdomyolysis]]
* [[Rhabdomyolysis]]
* [[Sea snake poisoning]]
* [[Sea snake poisoning]]
* [[Selective impairment of potassium excretion]]
* Selective impairment of [[potassium ]]excretion
* [[Sickle cell disease]]
* [[Sickle cell disease]]
* [[Sodium thiopental]]
* [[Sodium thiopental]]
Line 256: Line 282:
* [[Thrombocytosis]]
* [[Thrombocytosis]]
* [[Transplant rejection]]
* [[Transplant rejection]]
* [[Transplanted kidneys]]
* [[Triamterene]]
* [[Triamterene]]
* [[Trimethoprim]]
* [[Trimethoprim]]
Line 262: Line 287:
* [[Tumor lysis syndrome]]
* [[Tumor lysis syndrome]]
* [[Tungsten]]
* [[Tungsten]]
* [[Ureterojejunostomy]]
* Ureterojejunostomy
* [[Urinary tract obstruction]]
* [[Urinary tract obstruction]]
* [[Urolithiasis]]
* [[Urolithiasis]]
* [[Using clenched fist while  collection of blood]]
* Using clenched fist while  collection of blood
* [[Volume depletion]]
* [[Volume depletion]]
* [[White Chameleon poisoning]]
* White Chameleon poisoning
{{EndMultiCol}}
{{EndMultiCol}}
=== 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===
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.
===Pseudohyperkalemia===
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>


==References==
==References==
{{Reflist|2}}  
{{Reflist|2}}


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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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