Hyperkalemia

Etiology
Pseudohyperkalemia (falsely elevated levels):
Hemolysis
Repeated fist clenching with tourniquet in place
Thrombocytosis or leukocytosis will leak out of cells in the lab specimen
None needs further treatment beyond repeating the sample.
Decreased excretion:
Renal failure
Aldosterone decrease:
- ACE inhibitors/ ARBs
- Type IV renal tubular acidosis (hyporeninemic, hypoaldosteronism)
- Spironolactone and eplerenone (aldosterone inhibitors)
- Triamterene and amiloride (potassium-sparing diuretics)
- Addison disease
Release of potassium from tissues:
Any tissue destruction, such as hemolysis, rhabdomyolysis, or tumor lysis
syndrome, can release potassium.
Decreased insulin: Insulin normally drives potassium into cells.
Acidosis: Cells will pick up hydrogen ions (acid) and release potassium in
exchange.
Beta blockers and digoxin: These drugs inhibit the sodium/potassium
ATPase that normally brings potassium into the cells.
Heparin increases potassium levels, presumably through increased tissue release.
Presentation:
Potassium disorders interfere with muscle contraction and cardiac conductance.
Look for:
Weakness
Paralysis when severe
Ileus (paralyzes gut muscles)
Cardiac rhythm disorders
Hyperkalemia does not cause seizures
Diagnostic Tests
The most urgent test in severe hyperkalemia is an EKG.
EKG shows:
Peaked T waves
Wide QRS
PR interval prolongation
Treatment for severe:
1. Calcium chloride or calcium gluconate (Calcium is only used to protect heart.
It doesnt lower K+.
2. Insulin and glucose to drive potassium back into cells
3. Bicarbonate: drives potassium into cells but should be used most when
acidosis causes hyperkalemia.
Removing Potassium from the Body:
Sodium polystyrene sulfonate- removes potassium from the body through the
bowel. The patient

ingests Kayexalate orally and over several hours it will bind potassium in gut and
remove it from body.
Insulin and bicarbonate lower the k+ level through redistribution into the cells.
Other methods to lower potassium are:
Inhaled beta agonists (albuterol)
Loop diuretics
Dialysis
~TIP
When there is hyperkalemia and an abnormal EKG, the "most appropriate next step"
is clearly calcium chloride or gluconate.
Sodium = CNS symptoms
Hyperkalemia = muscular and cardiac symptoms