Hyperkalemia causes

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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]

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 arrhythmias.

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, 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
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, congenital
Iatrogenic	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
Infectious Disease	HIV infection
Musculoskeletal / Ortho	Muscle damage, Muscle wasting
Neurologic	Amelo-cerebro-hypohidrotic syndrome, Kohlschutter-Tonz syndrome
Nutritional / Metabolic	Arginine hydrochloride, Increased ingestion of high Potassium foods, Increased ingestion of Potassium containing drugs, 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, 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
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

Alphabetical order

Acidosis ACTH Deficiency Acute glomerulonephritis Acute renal failure Addisonian crisis Addison's disease Adrenal gland disorders Adrenal hyperplasia, congenital-type 3 Aldosterone antagonists Amelo-cerebro-hypohidrotic syndrome Amiloride Ammonium Bifluoride Amyloidosis - Renal Angiotensin receptor blockers Arginine hydrochloride Arsenicals Autoimmune adrenalitis Beta blockers Blood transfusion and complications Burns Celecoxib Chronic interstitial nephritis Chronic renal failure Cirrhosis Congenital adrenal hyperplasia -- sodium-wasting form Crush syndrome Cuffed blood sample Cyclosporine Dehydration Delayed separation blood sample Diabetes Diabetic ketoacidosis Diabetic nephropathy Diazoxide Digoxin Distal chloride shunt Drip arm sample EDTA blood sample Eplerenone Epsilon amino caproic acid (EACA) Erythropoietin Fasting Fluoride toxicity Foxglove poisoning Gastrointestinal bleeding Gordon's syndrome Heart failure Hemolysed blood sample Hemolytic anemia Hemolytic uremic syndrome Heparin HIV infection Hyperglycemia Hyperkalemic periodic paralysis Hyperkalemic Renal tubular acidosis Hypernatremia Hyperosmolality Hyperphosphataemia Hypoadrenocorticism -- hypoparathyroidism -- moniliasis Hyporeninemic hypoaldosteronism Hypothermia Ibuprofen

Increased ingestion of high potassium foods Increased ingestion of potassium containing drugs Indomethacin Internal bleeding Intravenous infusion Isoflurane Isolated aldosterone synthase deficiency IV fluids containing Potassium Ketoprofen Kohlschutter-Tonz syndrome Leukaemia Leukocytosis Lipoid congenital adrenal hyperplasia Low-molecular weight heparin Lupus nephritis Malignant hyperpyrexia Malnutrition Mannitol Melarsoprol Methotrexate Minoxidil Muscle damage Muscle wasting Naproxen Obstructive uropathy Oleander Poisoning Oxalate blood sample Pancuronium bromide Phlebotomy complication Pimecrolimus Polycystic kidney disease Potassium chloride Potassium citrate Propofol infusion syndrome Pseudohyperkalaemia, familial, due to red cell leak 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 Transplant rejection Transplanted kidneys Triamterene Trimethoprim Tubulointerstitial disease Tumor lysis syndrome Tungsten Ureterojejunostomy Urinary tract obstruction Urolithiasis Using clenched fist while collection of blood Volume depletion White Chameleon poisoning

Ineffective elimination from the body

• Renal insufficiency
• Medication that interferes with urinary excretion:
  • ACE inhibitors and angiotensin receptor blockers
  • Potassium-sparing diuretics (e.g. amiloride and spironolactone)
  • NSAIDs such as ibuprofen, naproxen, or celecoxib
  • The calcineurin inhibitor immunosuppressants ciclosporin and tacrolimus
  • The antibiotic trimethoprim
  • The antiparasitic drug pentamidine
• Mineralocorticoid deficiency or resistance, such as:
  • Addison's disease
  • 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, 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

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. 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).; or by a delay in the processing of the blood specimen. It can also occur in specimens from patients with abnormally high numbers of platelets (>1,000,000/mm³), leukocytes (> 100 000/mm³), or erythrocytes (hematocrit > 55%). People with "leakier" cell membranes have been found, whose blood must be separated immediately to avoid pseudohyperkalemia.