Hyperkalemia laboratory findings: Difference between revisions
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{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com] ; {{ADG}} | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com] ; {{ADG}} | ||
==Overview== | ==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. | 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.<ref name="pmid27939860">{{cite journal |vauthors=Kogika MM, de Morais HA |title=A Quick Reference on Hyperkalemia |journal=Vet. Clin. North Am. Small Anim. Pract. |volume=47 |issue=2 |pages=223–228 |year=2017 |pmid=27939860 |doi=10.1016/j.cvsm.2016.10.009 |url=}}</ref> | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
Revision as of 14:45, 31 May 2017
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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] ; 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.[1]
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)
Psudeohyperkalemia
- Defined as the release of potassium from cells after their breakdown. Most commonly seen during blood collection, so it's required to repeat blood test in patients with a transient rise in potassium without any risk factors.
- Other causes include
- Clotting increases release of potassium from platelets
- In patients with history of leukamia where the WBC count is >120,000/microL the potassium is raised to cell fragility
- Hereditary (familial) forms of pseudohyperkalemia
References
- ↑ Kogika MM, de Morais HA (2017). "A Quick Reference on Hyperkalemia". Vet. Clin. North Am. Small Anim. Pract. 47 (2): 223–228. doi:10.1016/j.cvsm.2016.10.009. PMID 27939860.