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. 

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	insulin deficiency or resistance
pseudohypoaldosteronism	tumor lysis syndrome
renal insufficiency or failure
systemic lupus erythematosus
type IV renal tubular acidosis

 

Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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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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