Hyperkalemia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Hyperkalemia is a laboratory finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia. The following table summarize the differentiating features of causes of hyperkalemia.

Differential Diagnosis

Hyperkalemia is a laboratory finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia. The following table summarize the differentiating features of causes of hyperkalemia

Organ system	Conditions	Distinguishing features			Additional findings
Organ system	Conditions	Symptoms	Signs	Labs	Additional findings
Renal	Acute kidney injury^[1]	Nausea, vomiting, decreased urine output, fatigue, dyspnea, edema	Tremor, confusion, edema	Hyperkalemia, increased BUN and Cr, metabolic acidosis	Recently developed symptoms
	Chronic kidney disease^[2]	Nausea, vomiting, decreased urine output, fatigue, dyspnea, edema	Tremor, confusion, edema	Hyperkalemia, increased BUN and Cr, metabolic acidosis, hypocalcemia, hyperphosphatemia	Chronic underlying disease (DM, HTN), duration of symptoms ≥ 3 months
	Renal tubular acidosis type-4^[3]	Usually asyptomatic	Signs of underlying disease	Hyperkalemia, normal anion gap metabolic acidosis, urine PH< 5.5	History of diabetes mellitus
Endocrine	DKA^[4]	Change in mental status, abdominal pain	Decreased skin turgor, dry oral mucosa, tachycardia	Hyperglycemia, increased anion gap metabolic acidosis, ketonemia	Rapidly developing polyuria, polydipsia, and weight loss
	HHS^[5]	Change in mental status, abdominal pain	Decreased skin turgor, dry oral mucosa, tachycardia	Severe hyperglycemia, normal anion gap, increased serum osmolality	Polyuria, polydipsia, and weight loss develop more insidious
	Congenital adrenal hyperplasia (CAH)^[6]^[7]	Poor feeding, failure to thrive, precocious puberty, short statue, hirsutism, weight loss	Ambiguous genitalia, hypotension	Hyperkalemia, increased 17 hydroxyprogestrone, hyponatremia	Salt wasting
	Addison's disease	Skin hyperpigmentation, fatigue, salt craving, nausea and vomiting, amenorrhea, depression	Hyperpigmentation, hypotension, pubic and axillary hair loss	Hyperkalemia, decreased serum cortisol level	Diagnosis by cosyntropin test
Tissue break down	Tumor lysis syndrome^[8]	Fever, weight loss, symptoms related to underlying malignancy	Altered mental status, lymphadenopathy, muscle weakness	Hyperkalemia, hyperphosphatemia, hypocalcemia	History of underlying malignancy
Tissue break down	Rhabdomyolysis^[9]	Myalgia, fatigue	Altered mental status, hypotension	Hyperkalemia, increased muscle enzymes (CK, aldolase)	History of seizure, drug overdose, or trauma

References

↑ Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007). "Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury". Crit Care. 11 (2): R31. doi:10.1186/cc5713. PMC 2206446. PMID 17331245.
↑ Rodríguez Soriano J (2002). "Renal tubular acidosis: the clinical entity". J. Am. Soc. Nephrol. 13 (8): 2160–70. PMID 12138150.
↑ Hsu CY, Vittinghoff E, Lin F, Shlipak MG (2004). "The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency". Ann. Intern. Med. 141 (2): 95–101. PMID 15262664.
↑ Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.
↑ Arieff AI, Carroll HJ (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine (Baltimore). 51 (2): 73–94. PMID 5013637.
↑ Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, Meyer-Bahlburg HF, Miller WL, Montori VM, Oberfield SE, Ritzen M, White PC (2010). "Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline". J. Clin. Endocrinol. Metab. 95 (9): 4133–60. doi:10.1210/jc.2009-2631. PMC 2936060. PMID 20823466.
↑ Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B (2010). "Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies". Eur. J. Endocrinol. 162 (3): 597–602. doi:10.1530/EJE-09-0884. PMID 19955259.
↑ Coiffier B, Altman A, Pui CH, Younes A, Cairo MS (2008). "Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review". J. Clin. Oncol. 26 (16): 2767–78. doi:10.1200/JCO.2007.15.0177. PMID 18509186.
↑ Knochel JP (1982). "Rhabdomyolysis and myoglobinuria". Annu. Rev. Med. 33: 435–43. doi:10.1146/annurev.me.33.020182.002251. PMID 6282181.

Template:WikiDoc Sources

[pmid17331245-1] Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007). "Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury". Crit Care. 11 (2): R31. doi:10.1186/cc5713. PMC 2206446. PMID 17331245.

[pmid12138150-2] Rodríguez Soriano J (2002). "Renal tubular acidosis: the clinical entity". J. Am. Soc. Nephrol. 13 (8): 2160–70. PMID 12138150.

[pmid15262664-3] Hsu CY, Vittinghoff E, Lin F, Shlipak MG (2004). "The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency". Ann. Intern. Med. 141 (2): 95–101. PMID 15262664.

[pmid19564476-4] Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN (2009). "Hyperglycemic crises in adult patients with diabetes". Diabetes Care. 32 (7): 1335–43. doi:10.2337/dc09-9032. PMC 2699725. PMID 19564476.

[pmid5013637-5] Arieff AI, Carroll HJ (1972). "Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases". Medicine (Baltimore). 51 (2): 73–94. PMID 5013637.

[pmid20823466-6] Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, Meyer-Bahlburg HF, Miller WL, Montori VM, Oberfield SE, Ritzen M, White PC (2010). "Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society clinical practice guideline". J. Clin. Endocrinol. Metab. 95 (9): 4133–60. doi:10.1210/jc.2009-2631. PMC 2936060. PMID 20823466.

[pmid19955259-7] Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B (2010). "Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies". Eur. J. Endocrinol. 162 (3): 597–602. doi:10.1530/EJE-09-0884. PMID 19955259.

[pmid18509186-8] Coiffier B, Altman A, Pui CH, Younes A, Cairo MS (2008). "Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review". J. Clin. Oncol. 26 (16): 2767–78. doi:10.1200/JCO.2007.15.0177. PMID 18509186.

[pmid6282181-9] Knochel JP (1982). "Rhabdomyolysis and myoglobinuria". Annu. Rev. Med. 33: 435–43. doi:10.1146/annurev.me.33.020182.002251. PMID 6282181.

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Hyperkalemia differential diagnosis

Overview

Differential Diagnosis

References

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