Presentation
Presentation The classic presentation of hyperkalemia is typically underwhelming. No signs or symptoms are pathognomonic for this condition, although patients may rarely present with weakness or paresthesias. [saem.org]
An extensive literature review has been performed to present a comprehensive review of the causes and treatment of hyperkalemia. [ncbi.nlm.nih.gov]
Entire Body System
- Fatigue
Central muscle fatigue manifests as an overall sense of energy deprivation, while peripheral muscle fatigue manifests as a local, muscle-specific inability to do work.[1][2] Neuromuscular fatigue[edit] Nerves control the contraction of muscles by determining [en.wikipedia.org]
It can cause: Muscle fatigue Weakness Paralysis Abnormal heart rhythms (arrhythmias) Nausea Nov. 18, 2011 References Laboratory reference values. Potassium values. Rochester, Minn.: Mayo Foundation for Medical Education and Research. July 2011. [web.archive.org]
It can cause: Muscle fatigue Weakness Paralysis Abnormal heart rhythms (arrhythmias) Nausea Jan. 11, 2018 References What is hyperkalemia? National Kidney Foundation. https://www.kidney.org/atoz/content/what-hyperkalemia. Accessed Oct. 4, 2017. [mayoclinic.org]
Pearls and Pitfalls Obtain an ECG on patients with chronic kidney disease who present with generalized fatigue and weakness to quickly screen for hyperkalemia. [saem.org]
However, some individuals with hyperkalemia have reported nausea, fatigue, weakness, tingling, slow heart beat or faint pulse. How is Hyperkalemia Treated? There are several different approaches to treat hyperkalemia. [healthcentral.com]
- Weight Gain
Since polymenorrhea means women experience periods more frequently, some complain of enduring weight gain. Polymenorrhea can be uncomfortable and inconvenient. It can also cause problems with fertility and quality of life. [healthline.com]
The peripheral edema observed among celecoxib-treated subjects was not associated with significant weight gain (average increase less than 0.3 kg) or increased blood pressure. [doi.org]
Interestingly, adverse effects, including interdialytic weight gain, were similar between the two groups (71). [frontiersin.org]
Potassium-binding resins: associations with serum chemistries and interdialytic weight gain in hemodialysis patients. [mayoclinicproceedings.org]
Interestingly, adverse effects, including interdialytic weight gain, were similar between the two groups. Thus, these findings suggest that SZC is an effective and well-tolerated treatment for predialysis hyperkalemia in HD patients (Table 2). [mdpi.com]
Gastrointestinal
- Nausea
[…] excrete potassium in exchange for sodium.2 Metabolic acidosis, which often contributes to AKI or CKD, causes potassium to shift from the intracellular to the extracellular compartment.4 Renal impairment may present clinically with dehydration, oliguria, nausea [mdedge.com]
The patient presented with continuous tachycardia, palpitations, chest tightness, progressive nausea, irritability, progressive myasthenia gravis. Hyperkalemia, sepsis, acidosis, diabetes, postoperative esophageal cancer. [ncbi.nlm.nih.gov]
It can cause: Muscle fatigue Weakness Paralysis Abnormal heart rhythms (arrhythmias) Nausea Nov. 18, 2011 References Laboratory reference values. Potassium values. Rochester, Minn.: Mayo Foundation for Medical Education and Research. July 2011. [web.archive.org]
It can cause: Muscle fatigue Weakness Paralysis Abnormal heart rhythms (arrhythmias) Nausea Jan. 11, 2018 References What is hyperkalemia? National Kidney Foundation. https://www.kidney.org/atoz/content/what-hyperkalemia. Accessed Oct. 4, 2017. [mayoclinic.org]
Cardiovascular
- Hypotension
An 85 year-old woman on a drug regimen of sotalol, valsartan, spironolactone, and trimethoprim-sulfamethoxazole presented to the emergency department with hypotension and bradycardia. [ncbi.nlm.nih.gov]
[…] toxicity Clinical Features of Hyperkalemia History and examination findings Neurological effects Paraesthesia Weakness and flaccid paralysis (diaphragm is usually spared) Loss of reflexes Normal cranial nerves Normal sensory function Cardiovascular effects Hypotension [derangedphysiology.com]
The clinician should have a high index of suspicion for hyperkalemia in patients with chronic renal failure and other predisposing conditions, particularly in the setting of hypotension or shock. [saem.org]
Amal Mattu’s ECG Case of the Week – January 21, 2019 HPI: A 50-year-old male is brought into the emergency department from prison with bradycardia, hypotension, and altered mental status. [ecgweekly.com]
It can also cause urinary sodium wasting, leading to volume depletion and hypotension. [en.wikipedia.org]
- Slow Pulse
pulses, even as low as 35 in a minute, cold sweats, convulsions, syncope, death." [emedicine.medscape.com]
- Systolic Murmur
[…] click and heart murmur may indicate mitral valve prolapse.[1] A harsh holo-systolic murmur best heard at the left sternal border which increases with Valsalva may indicate hypertrophic obstructive cardiomyopathy.[1] An irregular rhythm indicates atrial [en.wikipedia.org]
Musculoskeletal
- Muscle Weakness
Careful monitoring of electrocardiogram changes and muscle weakness in hyperkalemia is important to determine its functional consequences. If these are observed to be severe, immediate correction of hyperkalemia is essential. [acls.com]
Ascending muscle weakness is a manifestation of hyperkalemia that can progress to flaccid paralysis that is comparable to Guillain-Barre syndrome.10 Hyperkalemic periodic paralysis is an autosomal dominant mutation of sodium channels in skeletal muscles [resources.acls.com]
Patients are usually asymptomatic, but can develop: nausea palpitations muscle weakness, often starting in legs muscle cramping paresthesias and numbness Physical Exam Signs of hyperkalemia include: weakness areflexia ascending paralysis hypoventilation [sharinginhealth.ca]
Hyperkalemia causes muscle weakness (paresthesias followed by weakness and finally flaccid paralysis) and cardiac toxicity. At serum K of 6mEq/L tall T waves appear on EKG, at serum of 7mEq/L the PR interval is prolonged. [cancertherapyadvisor.com]
Muscle Weakness, Urine, Respiratory Distress, Decreased Cardiac Contractility, EKG Changes and Reflexes. Next thing I wanna talk about with hyperkalemia is the management AIRED, AIRED. [nrsng.com]
Neurologic
- Flaccid Paralysis
In severe cases, weakness and flaccid paralysis may occur. [icd9data.com]
Fluoride toxicity Clinical Features of Hyperkalemia History and examination findings Neurological effects Paraesthesia Weakness and flaccid paralysis (diaphragm is usually spared) Loss of reflexes Normal cranial nerves Normal sensory function Cardiovascular [derangedphysiology.com]
In 94 patients, flaccid paralysis was described and in 25, severe muscular weakness; in 65 patients, these findings were associated with other symptoms. Concurrent renal failure was often documented. [ncbi.nlm.nih.gov]
- Paresthesia
Neuromuscular depolarization can also lead to poor action potentials, with accompanying paresthesias and weakness. return to top Signs, Symptoms, and Diagnosis history physical exam ECG changes lab investigations History A careful history, with emphasis [sharinginhealth.ca]
No signs or symptoms are pathognomonic for this condition, although patients may rarely present with weakness or paresthesias. [saem.org]
Signs and symptoms Patients with hyperkalemia may be asymptomatic, or they may report the following symptoms (cardiac and neurologic symptoms predominate): Generalized fatigue Weakness Paresthesias Paralysis Palpitations Evaluation of vital signs is essential [emedicine.com]
- Tingling
However, some individuals with hyperkalemia have reported nausea, fatigue, weakness, tingling, slow heart beat or faint pulse. How is Hyperkalemia Treated? There are several different approaches to treat hyperkalemia. [healthcentral.com]
Other signs and symptoms include muscular weakness, tingling of the hands, feet, and tongue, and a slow irregular pulse. [medical-dictionary.thefreedictionary.com]
You have numbness or tingling in your arms or legs. Your symptoms do not go away or get worse. You have questions or concerns about your condition or care. When should I seek immediate care or call 911? You have trouble breathing. [drugs.com]
Sometimes people with hyperkalemia report nonspecific symptoms such as muscle weakness, tiredness, tingling sensations, or nausea. [emedicinehealth.com]
With a patient who has marginal potassium levels, vital signs (including pulse rhythm) and any signs of dizziness, muscle weakness or cramping, numbness or tingling, and changes in balance should be closely monitored. [physio-pedia.com]
- Lethargy
Amal Mattu’s ECG Case of the Week – November 13, 2017 HPI: A 44-year-old man with PMHx of diabetes is transported to the ED by EMS for lethargy and altered mental status. His finger stick blood glucose measurement read as [...] [ecgweekly.com]
Venepuncture technique (e.g. prolonged tourniquet application) Clinical Manifestations Signs and Symptoms of Hyperkalaemia: Clinical features are often non specific Generalised muscle weakness Flaccid paralysis and paraesthesia of the hands and feet Lethargy [lifeinthefastlane.com]
[…] characterized by ↑ serum K+ Etiology Oliguria, tissue injury, burns, K+ in IV solutions, metabolic acidosis, renal failure, K+-sparing diuretics–eg, spironolactone, antibiotics–eg, cephalosporins, isoniazid, penicillin, epinephrine, histamine Clinical Lethargy [medical-dictionary.thefreedictionary.com]
However, clinical features are nonspecific and include general weakness, lethargy, or confusion. Deep tendon reflexes may be depressed or absent, though cranial nerves, diaphragm function, and sensation are typically normal. [emdocs.net]
CNS symptoms of digitalis toxicity include the following: Drowsiness Lethargy Fatigue Neuralgia Headache Dizziness Confusion or giddiness Hallucinations Seizures (rare) Paresthesias and neuropathic pain Visual aberration often is an early indication of [emedicine.medscape.com]
- Absent Deep Tendon Reflexes
deep tendon reflexes Diagnosis Suspect hyperkalemia in ALL patients with renal impairment, especially end-stage renal disease (ESRD) Serum potassium Can be artificially elevated by extravascular hemolysis Blood gas results may differ from standard metabolic [coreem.net]
deep tendon reflexes When hyperkalemia is discovered, investigate potential pathophysiologic mechanisms. [emedicine.medscape.com]
Workup
See Workup for more detail. [emedicine.com]
Axis
- Left Axis Deviation
Left axis deviation. Absent P waves. Example 6 Hyperkalaemia: Sine wave appearance with severe hyperkalaemia (K+ 9.9 mEq/L). Example 7 Hyperkalaemia: Huge peaked T waves. Sine wave appearance. [lifeinthefastlane.com]
Serum
- Potassium Increased
OBJECTIVE: To compare different strategies predicting hyperkalemia (serum potassium level ≥5.5 mEq/l) in hospitalized patients for whom medications triggering potassium-increasing drug-drug interactions (DDIs) were ordered. [ncbi.nlm.nih.gov]
In general, sudden serum potassium increases can lead to significant ECG abnormalities, while those that occur progressively over time can produce fewer ECG manifestations. [emdocs.net]
In general, there are 3 mechanisms by which hyperkalemia occurs: increased potassium release from cells, increased potassium intake, and decreased potassium excretion. [visualdx.com]
Increased urinary loses – potassium excretion occurs mostly in the distal nephrons and increased losses may be seen in diuretic use, increased aldosterone secretion, nonreabsorbable anions, and loss of gastric secretions. [acls.com]
- Insulin Increased
Insulin increases potassium uptake into liver and muscle cells.13 A decrease in insulin levels, as may occur in type 2 diabetes or DKA, can cause a buildup of extracellular potassium.4 Also, serum hypertonicity from hyperglycemia results in water movement [mdedge.com]
The insulin is usually given with an appropriate amount of glucose to prevent hypoglycemia following the insulin administration. Salbutamol (albuterol), a β2-selective catecholamine, is administered by nebuliser (e.g. 10–20 mg). [en.wikipedia.org]
- Hyperinsulinemia
INSULINE INSULIN Zie ook: INSULINOOM INSULINOMA Zie ook: LAAG BLOEDSUIKERGEHALTE LAGE BLOEDGLUCOSESPIEGEL HYPOGLYKEMIE HYPOGLYCEMIA DokterDokter: Hyperinsulinisme Hyperinsulinisme Hyperinsulinemie/Onverklaarbaar overgewicht Wikipedia (Eng): Hyperinsulinism Hyperinsulinemia [catsclem.nl]
Hyperinsulinemia/euglycemia therapy for calcium channel blocker poisoning. Pediatr Emerg Care. 2002 ; 18 :36–37. Crossref Medline Google Scholar 285. Cohen E, Du D, Joyce D, Kapernick EA, Volovik Y, Kelly JW, Dillin A. [doi.org]
- Bicarbonate Increased
The use of sodium bicarbonate was higher in the hyperkalaemic group. Sodium bicarbonate increases intracellular potassium shift due to improved metabolic acidosis and helps to correct hyperkalemia. [clinmedjournals.org]
QRS Wave
- Wide QRS Complex
There is atrial-sensed, ventricular-paced rhythm with a rate of approximately 95 and a very wide QRS complex (about 220ms) but the QRS morphology is not typical for right or left bundle branch block. [emdocs.net]
QRS complex changes (uniform widening) are often evident with increasingly worsening hyperkalemia. Loss of P waves then follows, ultimately leading to the formation of sine-waves - the fusion of wide QRS complexes with ST-T segments. [saem.org]
PR Interval
- Prolonged PR Interval
Notes The classic ECG progression in hyperkalemia is: Peaked T waves Prolonged PR interval and flattening of the P wave Widening of the QRS Sine wave However. you cannot rely on the ECG to rule out significant hyperkalemia. [first10em.com]
PR interval, wide QRS complex) as an alternative to 10 units of short acting insulin. [ncbi.nlm.nih.gov]
PR interval AV block sine wave ventricular fibrillation asystole However, the sensitivity of ECG changes is low, and severe elevation can be accompanied by a normal ECG. [sharinginhealth.ca]
ECG Examples Example 1 This ECG displays many of the features of hyperkalaemia: Prolonged PR interval. Broad, bizarre QRS complexes — these merge with both the preceding P wave and subsequent T wave. Peaked T waves. [lifeinthefastlane.com]
Rhythm
- Sinus Arrest
A surface 12-lead electrocardiogram presented sinus arrest with peaked T-wave. [escardio.org]
The authors hypothesized that poor coding of arrhythmias associated with extremes of hyperkalemia, such as sinus arrest and asystole, led to this discrepancy. [jasn.asnjournals.org]
T Wave
- Peaking T Wave
Tall, peaked T waves are typically the earliest manifestations of hyperkalemia and occur before changes to the QRS complex. In the absence of any other ECG findings, peaked T waves are rarely associated with life-threatening arrhythmias. [saem.org]
This distinguishes peaked T waves of hyperkalemia from hyperacute T waves of early MI which tend to have a broader base T wave. Peaked T waves of Hyperkalemia. Note the amplitude of the T exceeds the amplitude of the R. [emergencymedicinecases.com]
Demonstrates a ventricular junctional escape rhythm (41 beats/min), with absence of P waves and peaked T waves. [thepermanentejournal.org]
A woman in her 40's was found down: Sinus rhythm with wide QRS at 133 ms and obvious Peaked T-waves with obvious hyperkalemia. But there is also significant ST elevation in V1-V3. Is there anterior STEMI? The K = 8.1. [hqmeded-ecg.blogspot.com]
Other ECG Findings
- Electrocardiogram Change
Hemodialysis (HD) has been suggested as the definitive therapy for severe hyperkalemia in this population,although there is limited data regarding renal replacement options.We report a case of life-threatening hyperkalemia with electrocardiogram changes [ncbi.nlm.nih.gov]
Coincident, baseline, and follow-up electrocardiograms were examined for quantitative and qualitative changes in the QRS and T waves as well as the official cardiology readings. [cjasn.asnjournals.org]
Treatments involve inducing potassium loss.6-8 Electrocardiogram changes in hyperkalemia include a tall peaked T wave. [acls.com]
- Abnormal ECG
[…] disturbance: Calcium IV Salbutamol neb Insulin/glucose IV Bicarbonate IV if metabolic acidosis Dialysis : Urgent if unstable Rapid if stable but symptomatic or abnormal ECG, To consider if asymptomatic but severe level Resonium (Polystyrene sulfonate [rch.org.au]
Conclusions • Clinical suspicion of hyperkalemia should be aroused on the basis of history and examination findings in conjunction with any abnormal ECG findings. • Life-threatening hyperkalemia should be suspected in any patient with acute onset bradycardia [omicsonline.org]
[…] organic heart disease and an abnormal baseline ECG, bradycardia may be the only new ECG abnormality ECG changes have a sequential progression, which roughly correlate with the potassium level, but with the caveats mentioned above [2] Early ECG changes [emedicine.medscape.com]
Treatment
New treatments for hyperkalemia in development may offer better efficacy, tolerability and safety profiles than do existing approved treatments. [ncbi.nlm.nih.gov]
Treatment The urgency of treatment will depend primarily on whether ECG manifestations of hyperkalemia are present. [saem.org]
ACUTE TREATMENT Urgent treatment of hyperkalemia includes stabilizing the myocardium to protect against arrhythmias and shifting potassium from the vascular space into the cells. [aafp.org]
Prognosis
Hyperkalemia Microchapters Home Patient information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Hyperkalemia from other Diseases Epidemiology and Demographics Risk Factors Screening Natural history, Complications and Prognosis [wikidoc.org]
Outlook / Prognosis What is the prognosis (outlook) for people who have hyperkalemia (high potassium)? Changes to your diet and medication often resolve mild cases of hyperkalemia. [my.clevelandclinic.org]
The prognosis is excellent for patients with mild transient hyperkalemia if the inciting cause is addressed and treated. [ncbi.nlm.nih.gov]
Prognosis The prognosis for specifically correcting hyperkalemia is excellent. However, hyperkalemia is usually caused by kidney failure, an often irreversible and eventually fatal condition. [medical-dictionary.thefreedictionary.com]
Etiology
Although many causes of hyperkalemia exist, exogenous red blood cell transfusions are being recognized as the primary perioperative etiology. [ncbi.nlm.nih.gov]
Epidemiology
This review article provides an overview of the physiology and the pathophysiology of potassium metabolism and hyperkalemia, the epidemiology of hyperkalemia, and its acute and chronic management. [ncbi.nlm.nih.gov]
Hyperkalemia Microchapters Home Patient information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Hyperkalemia from other Diseases Epidemiology and Demographics Risk Factors Screening Natural history, Complications [wikidoc.org]
A more accurate determination of the frequency of hyperkalemia and of the clinical epidemiology of patients in whom this adverse event occurs could be very useful for planning strategies to prevent hyperkalemia and also for better managing this electrolyte [revportcardiol.org]
Pathophysiology
Ann Intern Med. 1993 Aug 15; 119 (4):296–301. [ PubMed ] [ Google Scholar ] DuBose TD., Jr Hyperkalemic hyperchloremic metabolic acidosis: pathophysiologic insights. [ncbi.nlm.nih.gov]
Hyperkalemia in heart failure is a condition that can occur with relative frequency because it is related to pathophysiological aspects of the disease, and favored by drugs that form the basis of chronic cardiac failure therapy. [imrpress.com]
Prevention
The evidence needed to support a treatment claim (reduction in serum potassium) differs from that needed to support a prevention claim (preventing hyperkalemia to allow renin angiotensin aldosterone system inhibitor treatment). [ncbi.nlm.nih.gov]
Usually, hyperkalemia results from several simultaneous problems, including the following: Kidney disorders that prevent the kidneys from excreting enough potassium Drugs that prevent the kidneys from excreting normal amounts of potassium (a common cause [msdmanuals.com]
However, the beta 2 receptors also actiave sodium potassium ATPase channels also helping prevent hyperkalemia during periods of exercise. [youtube.com]
In a normal person, hyperkalemia from too much potassium in the diet is prevented by at least three types of regulatory processes. First, various cells and organs act to prevent hyperkalemia by taking up potassium from the blood. [medical-dictionary.thefreedictionary.com]