Hyperkalemia information

Hyperkalemia
Hyperkalemia
Other names	Hyperkalaemia
	Electrocardiography showing precordial leads in hyperkalemia.
Pronunciation	/ˌhaɪpərkeɪˈliːmiə/ ;
Specialty	Critical care medicine, nephrology
Symptoms	Palpitations, muscle pain, muscle weakness, numbness
Complications	Cardiac arrest
Causes	Kidney failure, hypoaldosteronism, rhabdomyolysis, certain medications
Diagnostic method	Blood potassium > 5.5 mmol/L, electrocardiogram
Differential diagnosis	Pseudohyperkalemia
Treatment	Medications, low potassium diet, hemodialysis
Medication	Calcium gluconate, dextrose with insulin, salbutamol, sodium bicarbonate
Frequency	~2% (people in hospital)

Hyperkalemia is an elevated level of potassium (K⁺) in the blood.^[1] Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5 mmol/L defined as hyperkalemia.^[3]^[4] Typically hyperkalemia does not cause symptoms.^[1] Occasionally when severe it can cause palpitations, muscle pain, muscle weakness, or numbness.^[1]^[2] Hyperkalemia can cause an abnormal heart rhythm which can result in cardiac arrest and death.^[1]^[3]

Common causes of hyperkalemia include kidney failure, hypoaldosteronism, and rhabdomyolysis.^[1] A number of medications can also cause high blood potassium including spironolactone, NSAIDs, and angiotensin converting enzyme inhibitors.^[1] The severity is divided into mild (5.5–5.9 mmol/L), moderate (6.0–6.4 mmol/L), and severe (>6.5 mmol/L).^[3] High levels can be detected on an electrocardiogram (ECG).^[3] Pseudohyperkalemia, due to breakdown of cells during or after taking the blood sample, should be ruled out.^[1]^[2]

Initial treatment in those with ECG changes is salts, such as calcium gluconate or calcium chloride.^[1]^[3] Other medications used to rapidly reduce blood potassium levels include insulin with dextrose, salbutamol, and sodium bicarbonate.^[1]^[5] Medications that might worsen the condition should be stopped and a low potassium diet should be started.^[1] Measures to remove potassium from the body include diuretics such as furosemide, potassium-binders such as polystyrene sulfonate (Kayexalate) and sodium zirconium cyclosilicate, and hemodialysis.^[1] Hemodialysis is the most effective method.^[3]

Hyperkalemia is rare among those who are otherwise healthy.^[6] Among those who are hospitalized, rates are between 1% and 2.5%.^[2] It is associated with an increased mortality, whether due to hyperkalaemia itself or as a marker of severe illness, especially in those without chronic kidney disease.^[7]^[6] The word hyperkalemia comes from hyper- 'high' + kalium 'potassium' + -emia 'blood condition'.^[8]^[9]

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q Lehnhardt A, Kemper MJ (March 2011). "Pathogenesis, diagnosis and management of hyperkalemia". Pediatric Nephrology. 26 (3): 377–384. doi:10.1007/s00467-010-1699-3. PMC 3061004. PMID 21181208.
^ ^a ^b ^c ^d ^e ^f McDonald TJ, Oram RA, Vaidya B (20 October 2015). "Investigating hyperkalaemia in adults". BMJ. 351: h4762. doi:10.1136/bmj.h4762. PMID 26487322. S2CID 206907572.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP (October 2010). "European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution". Resuscitation. 81 (10): 1400–1433. doi:10.1016/j.resuscitation.2010.08.015. PMID 20956045.
^ ^a ^b Pathy MJ (2006). "Appendix 1: Conversion of SI Units to Standard Units". Principles and practice of geriatric medicine. Vol. 2 (4th ed.). Chichester [u.a.]: Wiley. p. Appendix. doi:10.1002/047009057X.app01. ISBN 9780470090558.
^ ^a ^b Mahoney BA, Smith WA, Lo D, Tsoi K, Tonelli M, Clase C (20 April 2005). "Emergency interventions for hyperkalaemia". Cochrane Database of Systematic Reviews. 2005 (2): CD003235. doi:10.1002/14651858.CD003235.pub2. PMC 6457842. PMID 15846652.
^ ^a ^b Kovesdy CP (March 2017). "Updates in hyperkalemia: Outcomes and therapeutic strategies". Reviews in Endocrine and Metabolic Disorders. 18 (1): 41–47. doi:10.1007/s11154-016-9384-x. PMC 5339065. PMID 27600582.
^ Einhorn LM, Zhan M, Hsu VD, Walker LD, Moen MF, Seliger SL, Weir MR, Fink JC (22 June 2009). "The Frequency of Hyperkalemia and Its Significance in Chronic Kidney Disease". Archives of Internal Medicine. 169 (12): 1156–1162. doi:10.1001/archinternmed.2009.132. PMC 3544306. PMID 19546417.
^ Cohen BJ, DePetris A (2013). Medical Terminology: An Illustrated Guide. Lippincott Williams & Wilkins. p. 326. ISBN 9781451187564. Archived from the original on 8 September 2017.
^ Herlihy B (2014). The Human Body in Health and Illness. Elsevier Health Sciences. p. 487. ISBN 9781455756421. Archived from the original on 8 September 2017.

[Leh2011-1] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q Lehnhardt A, Kemper MJ (March 2011). "Pathogenesis, diagnosis and management of hyperkalemia". Pediatric Nephrology. 26 (3): 377–384. doi:10.1007/s00467-010-1699-3. PMC 3061004. PMID 21181208.

[BMJ2015-2] ^ ^a ^b ^c ^d ^e ^f McDonald TJ, Oram RA, Vaidya B (20 October 2015). "Investigating hyperkalaemia in adults". BMJ. 351: h4762. doi:10.1136/bmj.h4762. PMID 26487322. S2CID 206907572.

[EU2010-3] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP (October 2010). "European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution". Resuscitation. 81 (10): 1400–1433. doi:10.1016/j.resuscitation.2010.08.015. PMID 20956045.

[Pat2006-4] Pathy MJ (2006). "Appendix 1: Conversion of SI Units to Standard Units". Principles and practice of geriatric medicine. Vol. 2 (4th ed.). Chichester [u.a.]: Wiley. p. Appendix. doi:10.1002/047009057X.app01. ISBN 9780470090558.

[Sm2005-5] Mahoney BA, Smith WA, Lo D, Tsoi K, Tonelli M, Clase C (20 April 2005). "Emergency interventions for hyperkalaemia". Cochrane Database of Systematic Reviews. 2005 (2): CD003235. doi:10.1002/14651858.CD003235.pub2. PMC 6457842. PMID 15846652.

[Kov2016-6] Kovesdy CP (March 2017). "Updates in hyperkalemia: Outcomes and therapeutic strategies". Reviews in Endocrine and Metabolic Disorders. 18 (1): 41–47. doi:10.1007/s11154-016-9384-x. PMC 5339065. PMID 27600582.

[7] Einhorn LM, Zhan M, Hsu VD, Walker LD, Moen MF, Seliger SL, Weir MR, Fink JC (22 June 2009). "The Frequency of Hyperkalemia and Its Significance in Chronic Kidney Disease". Archives of Internal Medicine. 169 (12): 1156–1162. doi:10.1001/archinternmed.2009.132. PMC 3544306. PMID 19546417.

[8] Cohen BJ, DePetris A (2013). Medical Terminology: An Illustrated Guide. Lippincott Williams & Wilkins. p. 326. ISBN 9781451187564. Archived from the original on 8 September 2017.

[9] Herlihy B (2014). The Human Body in Health and Illness. Elsevier Health Sciences. p. 487. ISBN 9781455756421. Archived from the original on 8 September 2017.

Hyperkalemia information

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Hyperkalemia

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