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Medical Intelligence from The New England Journal of Medicine — VI. Hyperkalemia. Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds mmol/l. It can be caused by reduced renal excretion, excessive. n engl j med ;3 january 15, mmol per liter.1,2 Hyperkalemia is defined as erate hyperkalemia) and more than mmol per.

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Diagnostic algorithm in hyperkalemia; adapted from Clinical Paediatric Nephrology. A similar picture can be nejn in patients with obstructive uropathy and renal tubular acidosis [ 1617 ]. It can be caused by reduced renal excretion, excessive intake or leakage of potassium from the intracellular space.

Basolateral transporters include a KCl cotransporter. The mechanisms involved are not yet completely understood. Please review our privacy policy.

Pathogenesis, diagnosis and management of hyperkalemia

If elevated serum potassium is found in an asymptomatic patient with no apparent cause, factitious hyperkalemia should be considered. Prevalence, pathogenesis, and functional significance of aldosterone deficiency in hyperkalemic patients with chronic renal insufficiency. In patients with unimpaired renal function and intact other regulatory mechanisms, large amounts of potassium are hyperkallemia to achieve hyperkalemia [ 11 ].

Used with permission from [ 40 ] RTA renal tubular acidosis.

Symptoms are non-specific and predominantly related to muscular or cardiac dysfunction. Addison or secondary e. Depending on diet, the normal daily intake can vary. Anja Lehnhardt and Markus J. Handling of potassium in the nephron depends on passive and active mechanisms.

National Center for Biotechnology InformationU. Potassium is filtered in the glomerulus and almost completely reabsorbed in the proximal tubule and the loop of Henle. Acute increase in osmolality secondary to hyperglycemia or mannitol infusion causes potassium to exit from cells [ 24 ]. Human cortical distal nephron: Regulation of renal ion transport by the calcium-sensing receptor: Pseudohypoaldosteronism PHA refers to a heterogeneous hypsrkalemia of disorders of electrolyte metabolism characterized by hyperkalemia, metabolic acidosis, and normal GRF [ 18 ].


Management should not only rely on ECG changes but be guided by the clinical scenario and serial potassium measurements [ 2931 ]. Combined treatment with spironolactone and ACE inhibitors, hyperkalsmia in patients with renal impairment hyperkaoemia heart failure, has to be monitored very carefully. This can be the case in patients with rhabdomyolysis, tumorlyis, hemolysis, or after massive transfusion.

In hemodialysis patients with hyperkalemia it has only a moderate effect if given as prolonged infusion [ 35 ].

Pediatric Nephrology Berlin, Nsjm. Ion-exchange resins containing calcium or sodium aim to keep enteral potassium from being resorbed. Am J Emerg Med. Cortisol, beta hydroxylase or hydroxylase or OH progesterone in plasma. Non-steroidal anti-inflammatory drugs NSAIDs; ibuprofen, naproxen and ACEI angiotensin converting enzyme inhibitors as well as angiotensin receptor inhibitors can cause a decrease in aldosterone and GFR and thereby lead to hyperkalemia [ 13 ].

Martyn JA, Richtsfeld M.

Sustained-release potassium chloride overdose. Especially when capillary samples are taken, excess alcohol on the skin should be avoided, as it is the primary cause of the hemolysis in this process. Hyperkalemia can be classified according to serum potassium into mild 5. Effect of vasopressin analogue dDAVP on potassium transport in medullary collecting duct.

Salbutamol hyprkalemia been shown to be safe and even superior to rectal cation-exchange resin in nonoliguric preterms with hyperkalemia [ 34 ].


Succinylcholine, especially when given to patients with burn injuries, immobilization, or inflammation [ 26 ]. In children with severe hyperkalemia and major ECG abnormalities, conservative efforts should be initiated immediately to stabilize the patient, but management should include rapid facilitation of renal replacement treatment. Curr Opin Nephrol Hypertens. Correction factors have been discussed, but blood usually has to be drawn again [ 30 ].

If given iv, the lowering effect of salbutamol is quite predictable with a mean decrease of 1. Potassium homeostasis and Renin-Angiotensin-aldosterone system inhibitors. Pseudohyperkalemia If elevated serum potassium nej, found in an asymptomatic patient with no apparent cause, factitious hyperkalemia should be considered.

Pathogenesis, diagnosis and management of hyperkalemia

Structural and functional study of the rat distal nephron: In addition to acute and chronic renal failure, hypoaldosteronism, and massive tissue breakdown as in rhabdomyolysis, are typical conditions leading to hyperkalemia. Hyperialemia of prolonged bicarbonate administration on plasma potassium in terminal renal failure.

Abstract Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds 5. Correction of factitious hyperkalemia in hemolyzed specimens.

J Toxicol Clin Toxicol. Renal mechanisms of potassium handling Handling hyperlalemia potassium in the nephron depends on passive and active mechanisms. Absorption of potassium from the gastrointestinal tract is rapid and usually complete.