5-Minute Emergency Consult
Hyperkalemia
Hyperkalemia is a topic covered in the 5-Minute Emergency Consult.
To view the entire topic, please sign in or purchase a subscription.
Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
-- The first section of this topic is shown below --
Basics
Description
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
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
- Metabolic acidosis:
- Excess exogenous potassium load:
- Cellular breakdown:
- Trauma
- Tumor lysis
- Salt substitutes
- Oral potassium
- Potassium penicillin G
- Rapid transfusions of banked blood
- Cellular breakdown:
- 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
-- To view the remaining sections of this topic, please sign in or purchase a subscription --
Basics
Description
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
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
- Metabolic acidosis:
- Excess exogenous potassium load:
- Cellular breakdown:
- Trauma
- Tumor lysis
- Salt substitutes
- Oral potassium
- Potassium penicillin G
- Rapid transfusions of banked blood
- Cellular breakdown:
- 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
There's more to see -- the rest of this entry is available only to subscribers.
Citation
Rosen, Peter, et al., editors. "Hyperkalemia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307305/all/Hyperkalemia.
Hyperkalemia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307305/all/Hyperkalemia. Accessed January 17, 2020.
Hyperkalemia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307305/all/Hyperkalemia
Hyperkalemia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2020 January 17]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307305/all/Hyperkalemia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Hyperkalemia
ID - 307305
ED - Rosen,Peter,
ED - Shayne,Philip,
ED - Barkin,Adam Z,
ED - Wolfe,Richard E,
ED - Hayden,Stephen R,
ED - Barkin,Roger M,
ED - Schaider,Jeffrey J,
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 -