Hyperkalemia
Evaluation
General—serum potassium (K) ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b5f5104f2480c94b2ae34a00487f2ae81}/ID(AB1-M10)”>>5.0 mmol per L
Clinical
Often asymptomatic especially when mild.
Weakness, paralysis, and cardiac abnormalities may occur when severe (K ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b5f5104f2480c94b2ae34a00487f2ae81}/ID(AB1-M10)”>>6.5 mmol/L).
The severity of the presentation parallels the degree of hyperkalemia.
Therefore, worsening cardiac manifestations are seen on electrocardiogram (EKG) with hyperkalemia and may be rapid:
Etiology
Reduced renal excretion (the kidney eliminates ˜90% of dietary potassium)
Acute oliguric renal failure or chronic renal failure with a glomerular filtration rate (GFR) <A onclick="get_content(event,'AB1-M12'); return false;" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title="<15 mL per minute
Mineralocorticoid deficiency
Addison’s disease
Psychiatric correlate—Addison’s may present with psychiatric symptoms including depression, irritability, psychosis, and cognitive impairment.
Renin and/or aldosterone deficiency
Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
Work by decreasing aldosterone blood levels.
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Medications that inhibit potassium secretion in the distal nephron
Potassium-sparing diuretics (triamterene, amiloride, spironolactone)
Trimethoprim (TMP) of trimethoprim-sulfamethoxazole (TMP-SMZ)
Type IV renal tubular acidosis (RTA)
Transcellular shifts (potassium moves from intracellular space to extracellular space)
Acidosis—a decrease in plasma pH of 0.1 causes an increase in serum potassium of 0.6 mmol per L
Hyperosmolality (as occurs in diabetic ketoacidosis or other causes of severe hyperglycemia)
But, in diabetic ketoacidosis osmotic diuresis reduces the level of total body potassium.
Insulin deficiency (insulin helps to bring potassium into cells)
β2-Blockers (rarely cause clinically significant hyperkalemia alone)Related posts:
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