The approach to hyperkalemia (Fig.

3-3) is to determine whether increases

in serum potassium are spurious, caused by shifts of potassium from cellular
to extracellular spaces, or represent a true increase in total body potassium.
Spurious hyperkalemia is caused by red blood cell hemolysis in vitro,
ischemic blood draws, extreme thrombocytosis (greater than 1 million mL),
or leukocytosis (greater than 50,000 mL). Spurious hyperkalemia is distinguished
from true hyperkalemia by the absence of electrocardiographic
(ECG) abnormalities. Hyperkalemia caused by cell shifts of potassium
occurs acutely and results from decreased potassium transfer into cells (with
decreases
in insulin or -adrenergic blocker therapy), increased potassium
movement from cells to the extracellular space (with metabolic acidosis),
hypertonicity
(with hyperglycemia or the administration of mannitol), exercise,
muscle breakdown (with rhabdomyolysis), or drug intoxications from
digitalis or succinylcholine.
Chapter 3 The Patient with Hypokalemia or Hyperkalemia 55

Cardiovascular
Electrocardiographic abnormalities: U waves, QT prolongation, ST depression
Predisposition to digitalis toxicity
Atrial/ventricular arrhythmias
Neuromuscular
Skeletal muscle
Weakness
Cramps
Tetany
Paralysisflaccid
Rhabdomyolysis
Smooth muscle
Constipation
Ileus
Urinary retention