Hyperkalemia

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Original Editors -Courtney Ahlers & Jessica Ketterer from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Hyperkalemia is characterized by an elevated serum potassium level greater than 5.5 mmol/L and is classified as an electrolyte abnormality.   Acute hyperkalemia is often preceded by issues such as illness, dehydration, or introduction of medications that affect potassium levels.  

Prevalence

Approximately 1 to 10 percepnt of hospital patients are affected by hyperkalemia. 

The mortality rate for patients with hyperkalemia is approximately 1 in 1000.

Characteristics/Clinical Presentation

Hyperkalemia most commonly occurs in patients with chronic renal failure.

Associated Co-morbidities

Table 1                                 Disorders Causing Hyperkalemia
Disorders leading to hyperkalemia caused by impaired renal excretion of potassium	Disorders leading to hyperkalemia caused by shift of potassium into the extracellular space
acquired hyporeninemic hypoaldosteronism	acidosis
Addison's disease	damage to tissue from rhabdomyolysis, burns, or trauma
congenital adrenal hyperplasia (recessive or autosomal dominant)	familial hyperkalemic periodic paralysis
mineralocorticoid deficiency	hyperosmolar states (uncontrolled diabetes, glucose infusions)
primary hypoaldosteronism or hyporeninemia	tumor lysis syndrome
pseudohypoaldosteronism	insulin deficiency or resistance
renal insufficiency or failure
systemic lupus erythematosus
type IV renal tubular acidosis

 

     
 

Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

Hyperkalemia is typically caused when the kidneys can no longer excrete potassium, when the body is unable to effectively move potassium fro the extracellular space to within the cell, or a combination of the two. 

 

Systemic Involvement

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Medical Management (current best evidence)

Figure 2:  Algorithm for the management of hyperkalemia.

TABLE 5 Medications Used in Acute Treatment of Hyperkalemia
Medication	Dosage	Onset	Length of Effect	Mechanism of Action	Cautions
Calcium gluconate	10 to 20 mL of 10 percent solution IV over two to three minutes	immediate	30 minutes	Protects myocardium from toxic effects of calcium; no effect on serum potassium level	Can worsen digoxin toxicity
insulin	Regular insulin 10 units IV with 50 mL of 50 percent glucose	15 to 30 minutes	two to six hours	Shifts potassium out of the vascular space and into the cells; no effect on total body potassium	Consider 5 percent dextrose solution infusion at 100 mL per hour to prevent hypoglycemia with repeated doses. Glucose unnecessary if blood sugar elevated above 250 mg per dL (13.9 mmol per L)
Albuterol (Ventolin)	10 to 20 mg by nebulizer over 10 minutes (use concentrated form, 5 mg per mL)	15 to 30 minutes	two to three hours	Shifts potassium into the cells, additive to the effect of insulin; no effect on total body potassium	May cause a brief initial rise in serum potassium
Furosemide (Lasix)	20 to 40 mg IV, give with saline if volume depletion is a concern	15 minutes to one hour	four hours	Increases renal excretion of potassium	Only effective if adequate renal response to loop diuretic
Sodium polystyrene sulfonate (Kayexalate)	Oral: 50 g in 30 mL of sorbitol solution Rectal: 50 g in a retention enema	One to two hours (rectal route is faster)	four to six hours	Removes potassium from the gut in exchange for sodium	Sorbitol may be associated with bowel necrosis. May lead to sodium retention

IV = intravenously

• --Medications listed from most to least urgent.
  
  
  
  
  
  
  

Physical Therapy Management (current best evidence)

Potassium levels < 3.2 mEq/L or > 5.1 mEq/L contraindicated for physical therapy intervention due to the potential for arrhythmia and tetany.

Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

Pseudohyperkalemia occurs when lab reports indicate elevated serum potassium levels but the patient does not actually have elevated serum potassium.  This phenomenon occurs most commonly with destruction of red blood cells with collection of blood specimen.

Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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