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| {| class="infobox" style="float:right;" | | {| class="infobox" style="float:right;" |
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| | [[File:Siren.gif|30px|link=hyperkalemia resident survival guide]]|| <br> || <br> | | | [[File:Siren.gif|30px|link=Hyperkalemia resident survival guide]]|| <br> || <br> |
| | [[Hyperkalemia resident survival guide|Resident <br> Survival <br> Guide]] | | | [[Hyperkalemia resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| |} | | |} |
| '''For patient information, click [[Hyperkalemia (patient information)|here]]'''
| | {| class="infobox" style="float:right;" |
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| | | [[File:Critical_pathways_.gif|88px|link=Hyperkalemia critical pathways]]|| <br> || <br> |
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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]] |
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| | ==[[Hyperkalemia overview|Overview]]== |
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| {{SK}} Hyperkalaemia.
| | ==[[Hyperkalemia historical perspective|Historical Perspective]]== |
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| | ==[[Hyperkalemia classification|Classification]]== |
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| ==[[Hyperkalemia overview|Overview]]==
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| ''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
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| ==[[Hyperkalemia pathophysiology|Pathophysiology]]== | | ==[[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]].
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| 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 causes|Causes]]== |
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| | ==[[Hyperkalemia differential diagnosis|Differentiating Hyperkalemia from other Diseases]]== |
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| | ==[[Hyperkalemia epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Hyperkalemia risk factors|Risk Factors]]== |
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| 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 screening|Screening]]== |
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| 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 natural history, complications, and prognosis|Natural history, Complications and Prognosis]]== |
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| 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 ==[[causes|Causes]]==
| | ==Diagnosis== |
| __NOTOC__
| | [[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]] |
| {| class="infobox" style="float:right;"
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| | [[File:Siren.gif|30px|link=hyperkalemia resident survival guide]]|| <br> || <br> | |
| | [[Hyperkalemia resident survival guide|Resident <br> Survival <br> Guide]] | |
| |} | |
| {{Hyperkalemia}}
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| {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{RT}}
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| ==Causes== | | ==Treatment== |
| ===Common 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]] |
| * [[ACE inhibitors]]
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| * [[Acidosis]]
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| * [[Addisonian crisis]]
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| * [[Beta blockers]]
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| * [[Blood transfusion]] and complications
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| * [[Cirrhosis]]
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| * [[Diabetic nephropathy]]
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| * [[Increased ingestion of high potassium foods]]
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| * [[Malnutrition]]
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| * [[Renal tubular acidosis]]
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| * [[Renal failure]]
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| ===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}} |
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| [[Ammonium Bifluoride]], [[Arsenicals]], [[Fluoride]] toxicity, [[Foxglove]] [[Poisoning]], [[Oleander]] [[Poisoning]], [[Tungsten]], [[White Chameleon]][[Poisoning]]
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |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]]
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| | '''Endocrine'''
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| |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
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Cirrhosis]], [[Gastrointestinal bleeding]]
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |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
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| [[Hemolytic anemia]], [[Leukaemia]], [[Leukocytosis]], [[Sickle cell disease]], [[Thrombotic thrombocytopenic purpura]], congenital
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |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]]
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[HIV infection]]
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| [[Muscle damage]], [[Muscle wasting]]
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Amelo-cerebro-hypohidrotic syndrome]], [[Kohlschutter-Tonz syndrome]]
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Arginine hydrochloride]], Increased ingestion of high [[Potassium]] foods, Increased ingestion of [[Potassium]] containing drugs, [[Malnutrition]]
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |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
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Systemic lupus erythematosus]], [[Autoimmune adrenalitis]]
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| [[Crush syndrome]]
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |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|}
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| ===Causes in Alphabetical Order===
| | [[Category:Emergency medicine]] |
| {{MultiCol}}
| | [[Category:Nephrology]] |
| * [[Acidosis]]
| | [[Category:Laboratory tests]] |
| * [[ACTH Deficiency]]
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| * [[Acute glomerulonephritis]]
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| * [[Acute renal failure]]
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| * [[Addisonian crisis]]
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| * [[Addison's disease]]
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| * [[Adrenal gland disorders]]
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| * [[Adrenal hyperplasia]], congenital-type 3
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| * [[Aldosterone antagonists]]
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| * [[Amelo-cerebro-hypohidrotic syndrome]]
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| * [[Amiloride]]
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| * [[Ammonium Bifluoride]]
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| * [[Amyloidosis]] - Renal
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| * [[Angiotensin receptor blockers]]
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| * [[Arginine hydrochloride]]
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| * [[Arsenicals]]
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| * [[Autoimmune adrenalitis]]
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| * [[Beta blockers]]
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| * [[Blood transfusion and complications]]
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| * [[Burns]]
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| * [[Celecoxib]]
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| * [[Chronic interstitial nephritis]]
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| * [[Chronic renal failure]]
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| * [[Cirrhosis]]
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| * [[Congenital adrenal hyperplasia]] -- sodium-wasting form
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| * [[Crush syndrome]]
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| * [[Cuffed blood sample]]
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| * [[Cyclosporine]]
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| * [[Dehydration]]
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| * [[Delayed separation blood sample]]
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| * [[Diabetes]]
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| * [[Diabetic ketoacidosis]]
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| * [[Diabetic nephropathy]]
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| * [[Diazoxide]]
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| * [[Digoxin]]
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| * [[Distal chloride shunt]]
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| * [[Drip arm sample]]
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| * [[EDTA blood sample]]
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| * [[Eplerenone]]
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| * [[Epsilon amino caproic acid (EACA)]]
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| * [[Erythropoietin]]
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| * [[Fasting]]
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| * [[Fluoride toxicity]]
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| * [[Foxglove poisoning]]
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| * [[Gastrointestinal bleeding]]
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| * [[Gordon's syndrome]]
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| * [[Heart failure]]
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| * [[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>
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| * [[Hemolytic anemia]]
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| * [[Hemolytic uremic syndrome]]
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| * [[Heparin]]
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| * [[HIV infection]]
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| * [[Hyperglycemia]]
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| * [[Hyperkalemic periodic paralysis]]
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| * Hyperkalemic [[Renal tubular acidosis]]
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| * [[Hypernatremia]]
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| * [[Hyperosmolality]]
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| * [[Hyperphosphataemia]]
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| * [[Hypoadrenocorticism]] -- [[hypoparathyroidism]] -- [[moniliasis]]
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| * [[Hyporeninemic hypoaldosteronism]]
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| * [[Hypothermia]]
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| * [[Ibuprofen]]
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| * [[Increased ingestion of high potassium foods]]
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| * [[Increased ingestion of potassium containing drugs]]
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| {{ColBreak}}
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| * [[Indomethacin]]
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| * [[Internal bleeding]]
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| * [[Intravenous infusion]]
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| * [[Isoflurane]]
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| * [[Isolated aldosterone synthase deficiency]]
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| * IV fluids containing [[Potassium]]
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| * [[Ketoprofen]]
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| * [[Kohlschutter-Tonz syndrome]]
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| * [[Leukaemia]]
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| * [[Leukocytosis]]
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| * [[Lipoid congenital adrenal hyperplasia]]
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| * [[Low-molecular weight heparin]]
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| * [[Lupus nephritis]]
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| * [[Malignant hyperpyrexia]]
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| * [[Malnutrition]]
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| * [[Mannitol]]
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| * [[Melarsoprol]]
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| * [[Methotrexate]]
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| * [[Minoxidil]]
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| * [[Muscle damage]]
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| * [[Muscle wasting]]
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| * [[Naproxen]]
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| * [[Obstructive uropathy]]
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| * [[Oleander]] [[Poisoning]]
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| * [[Oxalate blood sample]]
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| * [[Pancuronium bromide]]
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| * [[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>
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| * [[Pimecrolimus]]
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| * [[Polycystic kidney disease]]
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| * [[Potassium chloride]]
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| * [[Potassium citrate]]
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| * [[Propofol infusion syndrome]]
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| * [[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>
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| * [[Pseudohypoaldosteronism]] type 1
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| * [[Pseudohypoaldosteronism]] type II
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| * [[Pyrimidifen]]
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| * [[Renal tubular acidosis]], distal-type 1
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| * [[Renal tubular acidosis]], distal-type 4
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| * [[Rhabdomyolysis]]
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| * [[Sea snake poisoning]]
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| * [[Selective impairment of potassium excretion]]
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| * [[Sickle cell disease]]
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| * [[Sodium thiopental]]
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| * [[Somatostatin]] therapy
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| * [[Spironolactone]]
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| * [[Strenuous exercise]]
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| * [[Succinylcholine]]
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| * [[Suxamethonium]]
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| * [[Systemic lupus erythematosus]]
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| * [[Tacrolimus]]
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| * [[Thrombotic thrombocytopenic purpura]]-congenital
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| * [[Thrombocytosis]]
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| * [[Transplant rejection]]
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| * [[Transplanted kidneys]]
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| * [[Triamterene]]
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| * [[Trimethoprim]]
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| * [[Tubulointerstitial disease]]
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| * [[Tumor lysis syndrome]]
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| * [[Tungsten]]
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| * [[Ureterojejunostomy]]
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| * [[Urinary tract obstruction]]
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| * [[Urolithiasis]]
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| * [[Using clenched fist while collection of blood]]
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| * [[Volume depletion]]
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| * [[White Chameleon poisoning]]
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| {{EndMultiCol}}
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