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Hyperkalemia

Hyperkalemias

Hyperkalemia (hyperpotassemia) is the presence of an abnormally high concentration of potassium in the blood.


ECG in hyperkalemia
ECG in hyperkalemia
ECG in hyperkalemia, Public Domain

Presentation
  • An extensive literature review has been performed to present a comprehensive review of the causes and treatment of hyperkalemia.[ncbi.nlm.nih.gov]
  • Physiologic adaptation, structural cardiac disease, medication use, and degree of concurrent illness might predispose certain patients presenting with hyperkalemia to a lower or higher threshold for toxicity.[ncbi.nlm.nih.gov]
  • Abstract The majority of patients who present for kidney transplantation have end stage renal disease and are on dialysis. Those patients are known to be at risk for the development of hyperkalemia.[ncbi.nlm.nih.gov]
  • METHODS: Chart review of presentation, physical examination, laboratory tests, and treatment. RESULTS: Initial potassium level was 10 mEq/L; ventricular tachycardia was observed and treated.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: We present three cases of primary aldosteronism with long standing hypertension (more than 10 years) hypokalemia (2.0-3.0 mmol/l).[ncbi.nlm.nih.gov]
Fatigue
  • It can cause: Muscle fatigue Weakness Paralysis Abnormal heart rhythms (arrhythmias) Nausea Jan. 11, 2018 References What is hyperkalemia? National Kidney Foundation. . Accessed Oct. 4, 2017. Potassium, serum. Mayo Medical Laboratories. .[mayoclinic.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]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 30, 2019[patientslikeme.com]
  • When to call your healthcare provider Call your provider right away if you have any of the following: Chest pain ( call 911 ) Fainting ( call 911 ) Shortness of breath ( call 911 if severe ) Slow, irregular heartbeat Fatigue Dizziness Lightheadedness[saintlukeshealthsystem.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]
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]
  • […] patient with hyperkalemia includes the following: A patient with known hyperkalemia or a patient with renal failure with suspected hyperkalemia should have intravenous access established and should be placed on a cardiac monitor [2] In the presence of hypotension[emedicine.medscape.com]
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]
  • In most cases, this causes non-specific symptoms such as malaise, palpitations and muscle weakness and can only be detected with a blood test.[house.wikia.com]
  • Muscle weakness, poor appetite that does not improve. Feeling your heart beat rapidly (palpitations).[chemocare.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]
  • Sometimes people with hyperkalemia report nonspecific symptoms such as muscle weakness, tiredness, tingling sensations, or nausea .[emedicinehealth.com]
Cesarean Section
  • Dizygotic twin sisters were born by Cesarean section at 25 weeks' gestation. The younger sister developed acute hyperkalemia (7.4 mEq/L) at 10 days of age.[ncbi.nlm.nih.gov]
Flaccid Paralysis
  • 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]
  • In severe cases, weakness and flaccid paralysis may occur.[fpnotebook.com]
  • paralysis (diaphragm is usually spared) Loss of reflexes Normal cranial nerves Normal sensory function Cardiovascular effects Hypotension Bradycardia Biochemical abnormalities Normal anion gap metabolic acidosis (due to decreased renal ammoniagenesis[derangedphysiology.com]

Workup
Albuminuria
  • Here we examined the effect of patiromer treatment on serum aldosterone, blood pressure, and albuminuria in patients with chronic kidney disease on renin-angiotensin system inhibitors with hyperkalemia (serum potassium 5.1-6.5 mEq/l).[ncbi.nlm.nih.gov]
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]
Potassium Increased
  • RESULTS: We identified 132 incidences of hyperkalemia induced by 8413 potentially severe potassium-increasing DDIs among 76 467 patients.[ncbi.nlm.nih.gov]
  • RESULTS: Serum potassium level increased in 108 patients after surgery (P CONCLUSIONS: Preoperative serum potassium increased after parathyroidectomy with autotransplantation in patients with secondary hyperparathyroidism.[ncbi.nlm.nih.gov]
  • If serum potassium increases rapidly, cardiotoxicity will ensue. Reference: Rose BD, Post TW. Clinical Physiology of Acid-Base and Electrolyte Disorder, 5 th ed, McGraw-Hill, New York, 2001, pp. 383-396, 898-910. Squires RD, Huth EJ.[acls.com]
  • For every 0.1 unit decrease in blood PH, serum potassium increases by about 0.6 mmol/L (less if the acidosis is caused by organic acids) [2].[escardio.org]
Insulin Increased
  • Meanwhile, in respiratory acidosis, the effect on serum potassium level is small through an unknown mechanism.The hormone insulin increases the uptake of potassium into the cells. Therefore, insulin deficiency can cause hyperkalemia.[en.wikipedia.org]
Wide QRS Complex
  • Although MMA is a rare complication, the possibility of severe hyperkalemia should be considered in the differential diagnosis of patients with MMA presenting with wide QRS complex tachycardia.[ncbi.nlm.nih.gov]
  • Electrocardiogram (ECG) showed a pacemaker (PMK)-induced rhythm, with loss of atrial capture and wide QRS complexes.[ncbi.nlm.nih.gov]
  • ., prolonged PR interval, wide QRS complex) as an alternative to 10 units of short acting insulin.[ncbi.nlm.nih.gov]
  • Role of inducing K loss via the GI tract in the management of hyperkalemia Setting Recommendations Hyperkalemia with severe ECG changes (e.g. absent P waves, wide QRS complex) No role for inducing K loss via GI tract Moderately severe hyperkalemia with[doi.org]
Prolonged PR Interval
  • ., prolonged PR interval, wide QRS complex) as an alternative to 10 units of short acting insulin.[ncbi.nlm.nih.gov]
  • 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, prolonged QRS interval, loss of P wave, sine waves and finally ventricular fibrillation (see ECG guideline for normal values for age) ECG CHANGES DO NOT NECESSARILY PROGRESS IN ORDER OF SERIOUSNESS OR SEVERITY, IN RELATION TO THE SEVERITY[starship.org.nz]
  • 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]
Peaking T Wave
  • PATIENT CONCERNS: An 82-year-old male patient who presented typical electrocardiographic indications of hyperkalemia, including the absence of P waves, prolongation of QRS complex, sinoventricular conduction, bradyarrhythmia and tall peaked T waves.[ncbi.nlm.nih.gov]
  • Laboratory tests showed hyperkalemia (6.6 mmol/L), peaked T wave and a corrected QT interval of 510 ms.[ncbi.nlm.nih.gov]
  • They manifested similar initial symptoms (vomiting), abnormal serum potassium ( 8.0 mmol/L), and EKG's with peaked T waves. Both patients were treated for hyperkalemia and recovered without complication.[ncbi.nlm.nih.gov]
  • 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]
  • Two emergency physicians blinded to study objective independently examined each ECG for rate, rhythm, peaked T wave, PR interval duration and QRS complex duration.[ncbi.nlm.nih.gov]
Electrocardiogram Change
  • The most frequent causes of hyperkalemia in elderly patients are discussed and electrocardiogram changes and arrhythmias in hyperkalemia are analyzed, as well as their treatment and prevention.[ncbi.nlm.nih.gov]
  • 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]
  • Common medications included β blockers, insulin, and aspirin; 80% had potassium Conclusions: Given the poor sensitivity and specificity of electrocardiogram changes, there is no support for their use in guiding treatment of stable patients.[cjasn.asnjournals.org]
  • Treatments involve inducing potassium loss. 6-8 Electrocardiogram changes in hyperkalemia include a tall peaked T wave.[acls.com]
  • Acute treatments for hyperkalemia that is associated with electrocardiogram changes are well known, and include insulin and glucose, β-agonists, calcium and, if necessary, dialysis.[nature.com]

Treatment
  • The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT) aimed to evaluate the current knowledge pertaining to the emergency treatment of hyperkalemia.[ncbi.nlm.nih.gov]
  • Food and Drug Administration approval for the treatment of hyperkalemia in October 2015. A second potassium-binding resin, a zirconium cyclosilicate currently known as ZS-9, may provide yet another alternative to the archetypal treatment with SPS.[ncbi.nlm.nih.gov]
  • This article reviews the pathomechanisms leading to hyperkalemic states, its symptoms, and different treatment options.[ncbi.nlm.nih.gov]
  • EXPERT OPINION: Recently, patiromer was approved by the FDA as the first new potassium binder for the treatment of hyperkalemia in over 50 years.[ncbi.nlm.nih.gov]

Prognosis
  • 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]
  • Prognosis Hyperkalaemia is an independent risk factor for death and most fatal cases are complicated by AKI. Prevention Much dangerous hyperkalaemia is iatrogenic.[patient.info]

Etiology
  • Although many causes of hyperkalemia exist, exogenous red blood cell transfusions are being recognized as the primary perioperative etiology.[ncbi.nlm.nih.gov]
  • Clinicians should recognize that hyperkalemia is one of the etiologies of the Brugada-like electrocardiographic pattern.[ncbi.nlm.nih.gov]
  • The most common cause of hyperkalemia in older patients is that of iatrogenic medication-related etiology due to associated polymorbidity, polypharmacy and reduced reserve metabolic capacity.[ncbi.nlm.nih.gov]
  • The review includes a discussion of potassium homeostasis and the etiologies of hyperkalemia and focuses on the prompt recognition and treatment of hyperkalemia.[ncbi.nlm.nih.gov]
  • The agent most likely associated with colonic necrosis is 70% sorbitol, and animal data support that 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]
  • Epidemiologic data demonstrate strong associations of morbidity and mortality in patients with hyperkalemia but these associations appear disconnected in certain patient populations and in differing clinical presentations.[ncbi.nlm.nih.gov]
  • This review discusses the epidemiology, pathophysiology, and outcomes of hyperkalemia in heart failure; provides an overview of traditional and novel ways to approach management of hyperkalemia; and discusses the need for further research to optimally[ncbi.nlm.nih.gov]
  • Saint-Louis-Lariboisière-Fernand-Widal, Paris, France. 7 Division of Nephrology, Ambroise Paré university hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt, Paris, France. 8 INSERM U1018 Team5, Research Centre in Epidemiology[ncbi.nlm.nih.gov]
  • Definition: A serum potassium level 5.5 mEq/L Epidemiology Common electrolyte disorder 10% of hospitalized patients ( Elliott 2010 ) Causes Pseudohyperkalemia: extravascular hemolysis Renal failure (potassium is primarily eliminated by the kidneys) Acidosis[coreem.net]
Sex distribution
Age distribution

Pathophysiology
  • Genetic testing revealed mutations in two recently discovered genes, the study of which has helped to unravel the pathophysiologic pathways.[ncbi.nlm.nih.gov]
  • In addition, we provide a comprehensive review of the literature concerning similar cases previously reported, as well as a discussion of the pathophysiology of mannitol-induced hyperkalemia.[ncbi.nlm.nih.gov]
  • 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]
  • This review discusses the epidemiology, pathophysiology, and outcomes of hyperkalemia in heart failure; provides an overview of traditional and novel ways to approach management of hyperkalemia; and discusses the need for further research to optimally[ncbi.nlm.nih.gov]
  • 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]

Prevention
  • Severe hyperkalemia is a medical emergency, which requires immediate therapies, followed by interventions aimed at preventing its recurrence.[ncbi.nlm.nih.gov]
  • PURPOSE OF REVIEW: The aim of this paper is to discuss strategies for prevention and management of hyperkalemia in patients with heart failure, including the role of novel therapies.[ncbi.nlm.nih.gov]
  • Future investigations are warranted to confirm the relationship between high FFK and PRCA and to observe the effectiveness of other interventions to prevent PRCA due to ECD-related hyperkalemia.[ncbi.nlm.nih.gov]
  • 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]
  • In order to prevent inappropriate ICD shock, consideration should be given to the suspension of ICD therapies while intensive care treatment of extreme electrolyte derangements is being pursued.[ncbi.nlm.nih.gov]

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Last updated: 2014-05-06 22:04