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    Hyperkalemia

    Hyperkalemia is a topic covered in the 5-Minute Emergency Consult.

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    Basics

    Description

    • Potassium distribution:
      • Extracellular space: 2%
      • Intracellular space: 98%
    • Potassium excretion:
      • Renal: 90%
      • GI: 10%
    • Renal (80–90%) and extrarenal mechanisms maintain normal plasma concentration between 3.5 and 5 mmol/L.
    • Renal excretion of potassium affected by:
      • Dietary intake
      • Distal renal tubular function
      • Acid–base balance
      • Mineralocorticoids
    • Regulation between intracellular and extracellular potassium balance is affected by:
      • Acid–base balance
      • Insulin
      • Mineralocorticoids
      • Catecholamines
      • Osmolarity
      • Drugs

    Etiology

    • Decreased potassium excretion:
      • Most common cause: Renal failure (acute or chronic)
      • Distal tubular diseases:
        • Acute interstitial nephritis
        • Renal transplant rejection
        • Sickle cell nephropathy
        • Renal tubular acidosis (diabetes)
      • Mineralocorticoid deficiency:
        • Addison disease
        • Hypoaldosteronism
      • Drugs:
        • ACE inhibitors/angiotensin receptor blockers
        • β-blockers
        • Potassium-sparing diuretics
        • NSAIDs
        • Cyclosporine
        • High-dose trimethoprim
        • Lithium toxicity
    • Intracellular to extracellular potassium shifts:
      • Metabolic acidosis:
        • Serum K+ rises 0.2–1.7 mmol/L for each 0.1 U fall in arterial pH.
      • Hyperosmolar states
      • Insulin deficiency
      • Cell necrosis
      • Rhabdomyolysis
      • Hemolysis
      • Chemotherapy
      • Drugs:
        • Digitalis toxicity
        • Depolarizing muscle relaxants (e.g., succinylcholine)
        • β-blockers
        • α-agonists
      • Hyperkalemic periodic paralysis
    • Excess exogenous potassium load:
      • Cellular breakdown:
        • Trauma
        • Tumor lysis
      • Salt substitutes
      • Oral potassium
      • Potassium penicillin G
      • Rapid transfusions of banked blood
    • Pseudohyperkalemia:
      • Traumatic venipuncture with hemolysis
      • Postvenipuncture release of potassium can occur in the setting of:
        • Thrombocytosis (platelets >800,000/mm3)
        • Extreme leukocytosis (WBC >100,000/mm3)
      • Prolonged tourniquet time

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    Citation

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    TY - ELEC T1 - Hyperkalemia ID - 307305 ED - Barkin,Adam Z, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Shayne,Philip, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307305/all/Hyperkalemia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -