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]] | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
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|>8.5mEq/L | |>8.5mEq/L | ||
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*The first step in diagnosing hyperkalemia is to exclude pseudohyperkalemia by repeating the blood test. | *The first step in diagnosing hyperkalemia is to exclude [[pseudohyperkalemia]] by repeating the blood test. | ||
===Initial tests=== | ===Initial tests=== | ||
*Complete blood count (CBC) | *Complete blood count (CBC) | ||
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*Urine potassium, sodium, and osmolality <ref name="pmid2402122">{{cite journal| author=Conte G, Dal Canton A, Imperatore P, De Nicola L, Gigliotti G, Pisanti N et al.| title=Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure. | journal=Kidney Int | year= 1990 | volume= 38 | issue= 2 | pages= 301-7 | pmid=2402122 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2402122 }} </ref> | *Urine potassium, sodium, and osmolality <ref name="pmid2402122">{{cite journal| author=Conte G, Dal Canton A, Imperatore P, De Nicola L, Gigliotti G, Pisanti N et al.| title=Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure. | journal=Kidney Int | year= 1990 | volume= 38 | issue= 2 | pages= 301-7 | pmid=2402122 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2402122 }} </ref> | ||
*Aldosterone | *[[Aldosterone]] | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | A01 | | | | | | | | | | | | | | | | |A01=Hyperkalemia}} | {{familytree | | | | | | | A01 | | | | | | | | | | | | | | | | |A01=Hyperkalemia}} | ||
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===Cause specific=== | ===Cause specific=== | ||
*Blood glucose In patients with history of diabetes mellitus | *Blood glucose In patients with history of diabetes mellitus | ||
*Digoxin level | *[[Digoxin]] level | ||
*Arterial or venous blood gas (acidosis) | *Arterial or venous blood gas ([[acidosis]]) | ||
*Urinalysis (renal insufficiency) | *Urinalysis (renal insufficiency) | ||
*Serum cortisol and aldosterone levels (mineralocorticoid deficiency) | *Serum [[cortisol]] and [[aldosterone]] levels ([[mineralocorticoid]] deficiency) | ||
*Serum uric acid and phosphorus assays (tumor lysis syndrome) | *Serum uric acid and phosphorus assays (tumor lysis syndrome) | ||
*Serum creatinine phosphokinase (CPK) and calcium measurements and urine myoglobin test (crush injury or rhabdomyolysis) | *Serum [[Creatine kinase|creatinine phosphokinase]] (CPK) and calcium measurements and urine [[myoglobin]] test (crush injury or rhabdomyolysis) | ||
===Psudeohyperkalemia=== | ===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. | *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 | *Other causes include | ||
**Clotting increases release of potassium from platelets | **[[Coagulation|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 | **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 | **Hereditary (familial) forms of [[pseudohyperkalemia]] | ||
==References== | ==References== | ||
Revision as of 14:12, 13 July 2018
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Hyperkalemia laboratory findings On the Web |
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Risk calculators and risk factors for Hyperkalemia laboratory findings |
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
| 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
| 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.
- ↑ Conte G, Dal Canton A, Imperatore P, De Nicola L, Gigliotti G, Pisanti N; et al. (1990). "Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure". Kidney Int. 38 (2): 301–7. PMID 2402122.