Hyperkalemia laboratory findings: Difference between revisions

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Revision as of 14:32, 31 May 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2] ; Aditya Ganti M.B.B.S. [3]

Overview

In a patient who does not have a risk for hyperkalemia, repeating the blood test is indicated before taking any actions unless changes are present on electrocardiography.

Laboratory Findings

Hyperkalemia is defined as serum potassium greater than 5.0-5.5 mEq/L in adults. Levels higher than 7 mEq/L can lead to significant hemodynamic and neurologic consequences, whereas levels exceeding 8.5 mEq/L can cause respiratory paralysis or cardiac arrest and can quickly be fatal. In a patient who does not have a risk for hyperkalemia, repeating the blood test is indicated before taking any actions unless changes are present on electrocardiography.

Grade	Potassium level
Mild	5-7mEq/L
Moderate	7-8.5mEq/L
Severe	>8.5mEq/L

The first step in diagnosing hyperkalemia is to exclude pseudohyperkalemia by repeating the blood test.

Initial tests

Complete blood count (CBC)
Metabolic profile
Urine potassium, sodium, and osmolality
Aldosterone

Hyperkalemia

Exclude psuedohyperkalemia by repeating the blood test

Acute rise in potassium

Persistent hyperkalemia

Increase release of K+ from cells
Trauma,radiation therapy, DKA, metabolic acidosis

Decreased urinary excreation of K+
rule out aldosterone deficency
24 hr urine K+ excreation

Cause specific

Blood glucose In patients with history of diabetes mellitus
Digoxin level
Arterial or venous blood gas (acidosis)
Urinalysis (renal insufficiency)
Serum cortisol and aldosterone levels (mineralocorticoid deficiency)
Serum uric acid and phosphorus assays (tumor lysis syndrome)
Serum creatinine phosphokinase (CPK) and calcium measurements and urine myoglobin test (crush injury or rhabdomyolysis)

References

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-{{familytree | C01 | | | | | | | | | | C02 | | | | | | | | | | |C01=|C02=}}
+{{familytree | C01 | | | | | | | | | | C02 | | | | | | | | | | |C01=Acute rise in potassium|C02=Persistent hyperkalemia}}
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-{{familytree | D01 | | | | | | | | | | D02 | | | | | | | | C01=}}
+{{familytree | D01 | | | | | | | | | | D02 | | | | | | | | |D01=Increase release of K+ from cells<br> Trauma,radiation therapy, DKA, metabolic acidosis|D02= Decreased urinary excreation of K+<br> rule out aldosterone deficency<br> 24 hr urine K+ excreation}}
-{{familytree | |!| | | |!| | | |!| | | | | | | | | | | | | | | | | | | | }}
+{{familytree/end}}
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-{{familytree | D01 | | D02 | |D03| | | | | | | | | | D04 | | | | | | |D01= Follow up testing is indicated during gestation to detect seroconversion|D02= '''≤ 18 weeks of gestation'''<br> ❑  No further action indicated <br> '''>18 weeks of gestation'''<br>❑ Compare to previous serological tests and send samples to a reference laboratory to confirm the timing of infection| D03= ❑ '''Negative IgG''' and '''Positive IgM''' <br>❑ Does not have clinical relevance<ref name="pmid8968902">{{cite journal| author=Liesenfeld O, Press C, Montoya JG, Gill R, Isaac-Renton JL, Hedman K et al.| title=False-positive results in immunoglobulin M (IgM) toxoplasma antibody tests and importance of confirmatory testing: the Platelia Toxo IgM test. | journal=J Clin Microbiol | year= 1997 | volume= 35 | issue= 1 | pages= 174-8 | pmid=8968902 | doi= | pmc=229533 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8968902  }} </ref>|D04= ❑ '''Positive IgG and IgM'''<br> ❑ Seroconverted and fetus is at risk<br> ❑ Initiate treatment and consider PCR}}
-{{familytree/end}}
-<small>Table adopted from Management of Toxoplasma gondii Infection during Pregnancy<ref name="MontoyaRemington2008">{{cite journal|last1=Montoya|first1=Jose G.|last2=Remington|first2=Jack S.|title=Clinical Practice: Management ofToxoplasma gondiiInfection during Pregnancy|journal=Clinical Infectious Diseases|volume=47|issue=4|year=2008|pages=554–566|issn=1058-4838|doi=10.1086/590149}}</ref> </small>
 ===Cause specific===