Hyperkalemia

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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]; Raviteja Guddeti, M.B.B.S. [3]

Synonyms and keywords: Hyperkalaemia.

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

Pathophysiology

Potassium is the most abundant intracellular cation. It is critically important for many physiologic processes, including maintenance of cellular membrane potential, homeostasis of cell volume, and transmission of action potentials in nerve cells. Its main dietary sources are vegetables (tomato and potato), fruits (orange and banana) and meat. Elimination is through the gastrointestinal tract and the kidney.

The renal elimination of potassium is passive (through the glomeruli), and resorption is active in the proximal tubule and the ascending limb of the loop of Henle. There is active excretion of potassium in the distal tubule and the collecting duct; both are controlled by aldosterone.

Hyperkalemia develops when there is excessive production (oral intake, tissue breakdown) or ineffective elimination of potassium. Ineffective elimination can be hormonal (inaldosterone deficiency) or due to causes in the renal parenchyma that impair excretion.

Increased extracellular potassium levels result in depolarization of the membrane potentials of cells. This depolarization opens some voltage-gated sodium channels, but not enough to generate an action potential. After a short while, the open sodium channels inactivate and become refractory, increasing the threshold to generate an action potential. This leads to the impairment of neuromuscular, cardiac, and gastrointestinal organ systems. Of most concern is the impairment of cardiac conduction which can result in ventricular fibrillation or asystole.

Patients with the rare hereditary condition of hyperkalemic periodic paralysis appear to have a heightened sensitivity of muscular symptoms that are associated with transient elevation of potassium levels. Episodes of muscle weakness and spasms can be precipitated by exercise or fasting in these subjects.==[[Hyperkalemia ==Causes==

Resident Survival Guide

Hyperkalemia Microchapters
Home
Patient information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hyperkalemia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural history, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hyperkalemia On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hyperkalemia All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hyperkalemia
CDC on Hyperkalemia
Hyperkalemia in the news
Blogs on Hyperkalemia
Directions to Hospitals Treating Hyperkalemia
Risk calculators and risk factors for Hyperkalemia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [5]; Raviteja Guddeti, M.B.B.S. [6]

Causes

Common Causes

• ACE inhibitors
• Acidosis
• Addisonian crisis
• Beta blockers
• Blood transfusion and complications
• Cirrhosis
• Diabetic nephropathy
• Increased ingestion of high potassium foods
• Malnutrition
• Renal tubular acidosis
• Renal failure

Causes by Organ System

Cardiovascular	Heart failure, Volume depletion
Chemical / poisoning	Ammonium Bifluoride, Arsenicals, Fluoride toxicity, Foxglove Poisoning, Oleander Poisoning, Tungsten, White ChameleonPoisoning
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, hyperpyrexia, Phlebotomy complication, Rhabdomyolysis, Sea snake poisoning, Selective impairment of potassium excretion, exercise,Transplant rejection, Tumor lysis syndrome, Ureterojejunostomy|} Causes in 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 Thrombocytosis 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