|
|
| Line 274: |
Line 274: |
|
| |
|
|
| |
|
|
| |
| === Ineffective elimination from the body===
| |
| * [[Renal insufficiency]]
| |
| * [[Medication]] that interferes with urinary excretion:
| |
| ** [[ACE inhibitor]]s and [[angiotensin II receptor antagonist|angiotensin receptor blockers]]
| |
| ** Potassium-sparing [[diuretic]]s (e.g. [[amiloride]] and [[spironolactone]])
| |
| ** [[Non-steroidal anti-inflammatory drugs|NSAIDs]] such as [[ibuprofen]], [[naproxen]], or [[Celebrex|celecoxib]]
| |
| ** The [[Immunosuppressive drug#Drugs acting on immunophilins|calcineurin inhibitor]] immunosuppressants [[ciclosporin]] and [[Prograf|tacrolimus]]
| |
| ** The antibiotic [[trimethoprim]]
| |
| ** The antiparasitic drug [[pentamidine]]
| |
| * [[Mineralocorticoid]] deficiency or resistance, such as:
| |
| ** [[Addison's disease]]
| |
| ** [[Hypoaldosteronism|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=== | | === Excessive release from cells=== |
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.
Complete Differential Diagnosis of the Causes of Hyperkalemia
Most common
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, 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
|
| 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
Excessive release from cells
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.[1] 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).[2]; 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.[3]
References
- ↑ Sevastos N et al. (2006) Pseudohyperkalemia in serum: the phenomenon and its clinical magnitude. J Lab Clin Med, 147(3):139-44; PMID 16503244.
- ↑ Don BR et al. (1990) Pseudohyperkalemia caused by fist clenching during phlebotomy. N Engl J Med, 322(18):1290-2; PMID 2325722.
- ↑ Iolascon A et al. (1999) Familial pseudohyperkalemia maps to the same locus as dehydrated hereditary stomatocytosis. Blood, 93(9):3120-3; PMID 10216110.