23/10/2023, 09:59 Hyperkalaemia DDx • LITFL

Hyperkalaemia DDx
Chris Nickson Feb 23, 2023
●

HOME CCC

Overview
Hyperkalaemia is defined as serum potassium level > 5.5 mEq/L
Hyperkalaemia is potentially life-threatening due to the risk of cardiac dysrhythmias
Most patients begin to manifest significant ECG changes at serum levels > 6.5 mEq/L

Causes
Increased potassium intake (rare)
Oral (potassium supplements)
IV (transfusion of stored blood, supplement infusions)
Gastrointestinal hemorrhage
Increased release from tissues
Tissue injury
Rhabdomyolysis, tumour lysis syndrome
Burns, ischaemia, haemolysis
Intense physical activity
hyperthermia
Decreased renal excretion
Renal failure (acute and chronic)
Hypoaldosteronism, Addison’s, Chronic active hepatitis
Obstructive uropathy
https://litfl.com/hyperkalaemia-ddx/ 1/6
23/10/2023, 09:59 Hyperkalaemia DDx • LITFL

Transcellular shift
Acidosis:
Metabolic acidosis (diabetic ketoacidosis, mineral acid overdose)
Respiratory acidosis
Factitious (Pseudo-hyperkalaemia)
Laboratory error
Haemolysis of sample, clenched fist, ischaemic tourniquet
Sample taken from IV running potassium-containing fluid
Leucocytosis, thrombocytosis
Drugs causing hyperkalaemia
Transcellular shift/ release from tissues
Suxamethonium, Beta blockers, phenylephrine
Aldosterone inhibition
ACE inhibitors, Angiotensin II blockers
Heparin, spironolactone, Beta blockers
Increased aldosterone resistance (Trimethoprim, amiloride)
Inhibition Na/K/ATPase (Digoxin)
Potassium supplements and IV additives (Increase exogenous potassium)

References and Links

LITFL
CCC – Hyperkalaemia management
CCC – Hyperkalaemia
CCC – Hypokalaemia
CCC – Hypokalaemia Mind Map
ECG Library – Hyperkalaemia
ECG Library – Hypokalaemia
Clinical Case – Hyperkalaemia
CCC Differential Diagnosis Series
https://litfl.com/hyperkalaemia-ddx/ 2/6
23/10/2023, 09:59 Hyperkalaemia DDx • LITFL

Anosmia, Ataxia, Blepharospasm, Bulbar and Pseudobulbar palsy, Central Pontine

Myelinosis, Cerebellar Disease, Chorea, Cranial nerve lesions, Dementia,

Dystonia, Exophthalmos, Eye trauma, Facial twitches, Fixed dilated pupil, Horner
NEURO
syndrome, Loss of vision, Meningism, Movement disorders, Optic disc abnormality,
Parkinsonism, Peripheral neuropathy, Radiculopathy, Red eye, Retinal
Haemorrhage, Seizures, Sudden severe headache, Tremor, Tunnel vision

Bronchial breath sounds, Bronchiectasis, High airway pressures, Massive

RESP
haemoptysis, Sore throat, Tracheal displacement

Atrial Fibrillation, Bradycardia, Cardiac Failure, Chest Pain, Murmurs, Post-

resuscitation syndrome, Pulseless Electrical Activity (PEA), Pulsus Paradoxus,
CVS
Shock, Supraventricular tachycardia (SVT), Tachycardia, VT and VF, SVC

Obstruction

Abdominal distension, Abdominal mass, Abdominal pain, Asterixis, Dysphagia,

Hepatomegaly, Hepatosplenomegaly, Large bowel obstruction, Liver palpation

GIT
abnormalities, Lower GI haemorrhage, Malabsorption, Medical causes of
abdominal pain, Rectal mass, Small bowel obstruction, Upper GI Haemorrhage

Genital ulcers, Groin lump, Scrotal mass, Urine colour, Urine Odour, Urine
GUT
transparency,

MSK Arthritis, Shoulder pain, Wasting of the small muscles of the hand

Palmar erythema, Serious skin signs in sick patients, Thickened Tethered Skin, Leg
DERM
ulcers, Skin Tumour, Acanthosis Nigricans

Diabetes Insipidus, Diffuse Goitre, Gynaecomastia, Hirsutism, Hypoglycaemia,

ENDO
SIADH, Weight Loss

HAEM Splenomegaly

PAEDS Floppy infant

Anaphylaxis, Autoimmune associated diseases, Clubbing, Parotid Swelling, Splinter

MISC haemorrhages, Toxic agents and abnormal vitals, Toxicological causes of cardiac

arrest

CHEST: Atelectasis, Hilar adenopathy, Hilar enlargement on CXR, Honeycomb

lung, Increased interstitial markings, Mediastinal widening on mobile CXR,

Pulmonary fibrosis, Pseudoinfiltrates on CXR, Pulmonary opacities on CXR,

IMAGING ABDO: Gas on abdominal X-ray, Kidney mass,

BRAIN: Intracranial calcification, Intracranial structures with

contrast, Ventriculomegaly,

OTHER: Pseudofracture on X-Ray,

LABS LOW: Anaemia, Hypocalcaemia, hypochloraemia, Hypomagnesaemia,

HIGH: Bilirubin and Jaundice, Hyperammonaemia, Hypercalcaemia,

Hyperchloraemia, Hyperkalaemia, Hypermagnesaemia,

ACID BASE: Acid base disorders, Resp. acidosis, Resp. alkalosis,

https://litfl.com/hyperkalaemia-ddx/ 3/6
23/10/2023, 09:59 Hyperkalaemia DDx • LITFL

Creatinine, CRP, Dipstick Urinalysis, Laboratory Urinalysis, Liver function tests

(LFTs), Pleural fluid analysis, Urea, Urea Creatinine Ratio, Uric acid, Urinalysis,

Urine Electrolytes

[cite]

Critical Care
Compendium

…more CCC

Chris Nickson
Chris is an Intensivist and ECMO specialist at the Alfred ICU in
Melbourne. He is also a Clinical Adjunct Associate Professor at Monash
University. He is a co-founder of the Australia and New Zealand
Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN
Clinician Educator Incubator programme. He is on the Board of
Directors for the Intensive Care Foundation and is a First Part Examiner
for the College of Intensive Care Medicine. He is an internationally
recognised Clinician Educator with a passion for helping clinicians
learn and for improving the clinical performance of individuals and
collectives.
After finishing his medical degree at the University of Auckland, he
continued post-graduate training in New Zealand as well as Australia’s
Northern Territory, Perth and Melbourne. He has completed fellowship
training in both intensive care medicine and emergency medicine, as
well as post-graduate training in biochemistry, clinical toxicology,
clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve
patient care and the design of processes and systems at Alfred Health.
He coordinates the Alfred ICU’s education and simulation programmes
and runs the unit’s education website, INTENSIVE. He created the
‘Critically Ill Airway’ course and teaches on numerous courses around
the world. He is one of the founders of the FOAM movement (Free
https://litfl.com/hyperkalaemia-ddx/ 4/6
23/10/2023, 09:59 Hyperkalaemia DDx • LITFL

Open-Access Medical education) and is co-creator

of litfl.com, the RAGE podcast, the Resuscitology course, and
the SMACC conference.
His one great achievement is being the father of three amazing
children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

https://litfl.com/hyperkalaemia-ddx/ 5/6
23/10/2023, 09:59 Hyperkalaemia DDx • LITFL

MENU BLOG ECG CCC TOP 100 PODCASTS EPONYM MEDMASTERY PART ONE
INTENSIVE

© 2023 LITFL - Powered by Medmastery

#FOAMed Medical Education Resources by LITFL is licensed under a Creative Commons

Attribution-NonCommercial-ShareAlike 4.0 International License. Based on a work
at https://litfl.com

About • Authors • Analytics • Contact

Cookies • Disclaimer• Privacy

Blog Stats
160,246,347 visitors

https://litfl.com/hyperkalaemia-ddx/ 6/6