Medical Intelligence from The New England Journal of Medicine — VI. Hyperkalemia. Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds mmol/l. It can be caused by reduced renal excretion, excessive. n engl j med ;3 january 15, mmol per liter.1,2 Hyperkalemia is defined as erate hyperkalemia) and more than mmol per.

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Pathogenesis, diagnosis and management of hyperkalemia

Understanding the risk of hyperkalaemia in heart failure: PHA type I caused by autosomal dominant mutations in the human mineralocorticoid receptor MR gene is limited to the kidneys.

Excessive intake In patients with unimpaired renal function and intact other regulatory mechanisms, large amounts of potassium are needed to achieve hyperkalemia [ 11 ]. In anuric patients, treatment of hyperkalemia should include diuretics.

Prevalence, pathogenesis, and functional significance of aldosterone deficiency in hyperkalemic patients with chronic renal insufficiency. If elevated serum potassium is found in an asymptomatic patient with no apparent cause, factitious hyperkalemia nehm be considered.

Reduction in adrenal aldosterone biosynthesis through interrupting renin-aldosterone axis. Potassium homeostasis and Renin-Angiotensin-aldosterone hyperkalenia inhibitors. Retrospective review of the frequency of Hyyperkalemia changes in hyperkalemia. Hyperkalemic distal renal tubular acidosis associated with obstructive uropathy.

Pathogenesis of hyperkalemia Hyperkalemia may result from an increase in total body potassium secondary to imbalance of intake vs. Huang C, Miller RT. The mechanisms involved are not yet completely understood.


Cecal perforation hyperkalmeia with sodium polystyrene sulfonate-sorbitol enemas in a gram infant with hyperkalemia. Open in a separate window.

Therapeutic strategies should be individualized, taking into account the degree and the cause of hyperkalemia.

It should be noted, however, that reabsorption and secretion of potassium occur simultaneously, and that many modulators are important, such as diet, adrenal steroids, and acid-base balance. Clin J Am Soc Nephrol. Succinylcholine, especially when given to patients with burn injuries, immobilization, or inflammation neim 26 ]. Aldosterone and potassium secretion by the cortical collecting duct.

Ca-Gluconate does not have a potassium-lowering effect.

Extrarenal regulatory mechanisms of potassium metabolism Acid-base balance can affect the balance between cellular and extracellular potassium concentration. Acute increase in osmolality secondary to hyperglycemia or mannitol infusion causes potassium to exit from cells [ 24 ]. Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure.

Anja Lehnhardt and Markus J. Treatment has to be initiated immediately using different therapeutic strategies to increase potassium shift into the intracellular space or to increase elimination, together with reduction of intake. Which of the following clinical conditions typically causes hyperkalemia answer true or false for a through e acute renal failure.

Non-steroidal anti-inflammatory drugs NSAIDs; ibuprofen, naproxen and ACEI angiotensin converting enzyme inhibitors as well as angiotensin receptor inhibitors can cause a decrease in aldosterone and GFR and thereby lead to hyperkalemia [ 13 ].

Pathogenesis, diagnosis and management of hyperkalemia

Weir MR, Rolfe M. An inappropriately low TTKG in a hyperkalemic patient suggests hypoaldosteronism or a renal tubule hyperkalmia [ 39 ]. Induction of hyporeninemic hypoaldosteronism through inhibiting renal prostaglandin synthesis. Especially in pediatrics, mechanical hemolysis can occur during difficult blood draws, and even more hyperkalfmia samples with lymphocytosis or thrombocytosis.


Regulation of renal ion transport by the calcium-sensing receptor: Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds 5. In treatment of moderate to severe hyperkalemia, the combination of medications with different therapeutic approaches is usually effective, and often methods of blood purification can be avoided.

Oxford University Press, p This results from leakage of potassium from the intracellular space during or after blood sampling. If given iv, the lowering effect of salbutamol is quite predictable with a mean decrease of 1. Ion-exchange resins containing calcium or sodium hyperkalemja to keep enteral potassium from being resorbed.

Even in chronic hemodialysis patients, treatment with loop diuretics may be of value if the patient has some residual renal function [ 36 ]. Please review our privacy policy. Hypekalemia drug does not cause hyperkalemia? Published online Dec Renal tubular handling of potassium in children with insulin-dependent diabetes mellitus.

Diarrhea if preparations come premixed with sorbitol p. Effect of vasopressin analogue dDAVP on potassium transport in medullary collecting duct.