Learning objectives
- Definition, diagnosis, and management of hyperkalemia
Definition
- Hyperkalemia is an elevated level of potassium (K+) in the blood:
- Mild: a serum K+ 5.5 – 5.9 mmol/L
- Moderate: a serum K+6.0-6.4 mmol/L
- Severe: a serum K+ ≥ 6.5 mmol/L
Signs and symptoms
- Gastro-intestinal
- Nausea
- Vomiting
- Diarrhea
- Neuromuscular
- Paresthesias
- Muscle fasciculations
- Ascending paralysis of the extremities (quadriplegia)
- Cardiac
- Dyspnea
- Progressive ECG changes with increasing severity of hyperkalemia
- Peaked T wave
- Wide PR interval
- Wide QRS duration
- Loss of P wave
- Sinusoidal wave
Causes
| Renal failure | |
| Medications | Angiotensin-converting enzyme inhibitors (ACE-i) Angiotensin II receptor blockers (ARB) Potassium-sparing diuretics Non-steroidal anti-inflammatory drugs (NSAIDs) Beta-blockers Trimethoprim (antibiotic) |
| Tissue breakdown | Rhabdomyolysis Trauma |
| Endocrine disorders | Diabetes mellitus type 2 Adrenocortical insufficiency |
Management
- First, ensure that the lab result is correct and rule out pseudohyperkalemia
- Typical examples:
- Poor storage of blood specimens
- Long transport time from blood draw of the sample to processing in the lab
Suggested reading
- Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances [published correction appears in Resuscitation. 2021 Oct;167:91-92]. Resuscitation. 2021;161:152-219.
- Palmer BF, Carrero JJ, Clegg DJ, et al. Clinical Management of Hyperkalemia. Mayo Clin Proc. 2021;96(3):744-762.
- Palmer BF, Clegg DJ. Diagnosis and treatment of hyperkalemia. Cleve Clin J Med. 2017;84(12):934-942. doi:10.3949/ccjm.84a.17056
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