Hyperkalemia laboratory findings
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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.
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| {{{ D01 }}} | {{{ D02 }}} | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Follow up testing is indicated during gestation to detect seroconversion | ≤ 18 weeks of gestation ❑ No further action indicated >18 weeks of gestation ❑ Compare to previous serological tests and send samples to a reference laboratory to confirm the timing of infection | ❑ Negative IgG and Positive IgM ❑ Does not have clinical relevance[1] | ❑ Positive IgG and IgM ❑ Seroconverted and fetus is at risk ❑ Initiate treatment and consider PCR | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Table adopted from Management of Toxoplasma gondii Infection during Pregnancy[2]
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)
References
- ↑ Liesenfeld O, Press C, Montoya JG, Gill R, Isaac-Renton JL, Hedman K; et al. (1997). "False-positive results in immunoglobulin M (IgM) toxoplasma antibody tests and importance of confirmatory testing: the Platelia Toxo IgM test". J Clin Microbiol. 35 (1): 174–8. PMC 229533. PMID 8968902.
- ↑ Montoya, Jose G.; Remington, Jack S. (2008). "Clinical Practice: Management ofToxoplasma gondiiInfection during Pregnancy". Clinical Infectious Diseases. 47 (4): 554–566. doi:10.1086/590149. ISSN 1058-4838.