Pathophysiology of Hyperkalemia

Potassium is usually an intracellular cation. Total body potassium stores are 50 to 75 mEq/kg
body weight (approximately 3000 mEq).[6] The sodium-potassium pump is responsible for
maintaining potassium within the cells, which pumps sodium out of and potassium into the cell
in a 3:2 ratio. This results in approximately 140 mEq/L intracellular potassium concentration
compared with 4 to 5 mEq/L in the extracellular fluid. Most potassium is excreted in urine
through the kidneys, with about 10% in sweat and stool. Inside the kidney, potassium excretion
occurs in the distal convoluted and cortical collecting ducts.
Elevated levels of the following influence renal potassium excretion:
 Aldosterone
 Diuretics (which deliver sodium to the distal tubule)
 WNK1 and WNK4
 High levels of serum potassium
 A high flow of urine (osmotic diuresis)
 Presence of negative ions in the distal tubule (bicarbonate