The difference between hyperkalemia and hypokalemia.

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 05, 2024
00:00
00:00

Hypokalemia refers to a serum potassium concentration lower than 3.5mmol/L, and its clinical manifestations are diverse. The most life-threatening symptoms involve the cardiac conduction system and the neuromuscular system. Mild hypokalemia shows on an electrocardiogram as flattened T waves and the appearance of U waves, while severe hypokalemia can lead to fatal arrhythmias, such as torsades de pointes and ventricular fibrillation. In terms of the neuromuscular system, the most prominent symptom of hypokalemia is the loss of tone in smooth muscles and flaccid paralysis in skeletal muscles, which, when involving respiratory muscles, can lead to respiratory failure. Hyperkalemia, on the other hand, refers to a serum potassium concentration exceeding 5.5mmol/L, mainly presenting clinical symptoms in cardiac and neuromuscular conduction. Severe cases can cause bradycardia, atrioventricular conduction block, and even sinus arrest. Mild hyperkalemia, with levels between 5.5 to 6.0mmol/L, shows on an electrocardiogram as peaked T waves. As hyperkalemia continues to increase, it can lead to lengthening of the PR interval or disappearance of the P wave, QRS widening, and eventually cardiac arrest. Regarding the neuromuscular system, the clinical manifestations of hyperkalemia are very similar to those of hypokalemia, including weakness and paralysis of skeletal and smooth muscles.

Other Voices

doctor image
home-news-image
Written by Wei Shi Liang
Intensive Care Unit
49sec home-news-image

The role of calcium agents in hyperkalemia

Change the excitability of autonomic cells to protect the heart. Hyperkalemia mainly affects the conduction of the heart and neuromuscular system. Typical clinical manifestations include severe bradycardia, atrioventricular block, and even sinus arrest. By using calcium agents to change the excitability of autonomic cells, we can protect the heart from the damage to the conduction system caused by hyperkalemia. This allows the potassium ions to move from outside the cell to inside the cell. While protecting the myocardium, it is also necessary to use some medications to lower blood potassium. If the blood potassium is particularly high, dialysis or continuous bedside blood filtration can be used to reduce the blood potassium to a normal range.

doctor image
home-news-image
Written by Wei Shi Liang
Intensive Care Unit
56sec home-news-image

What are the causes of hyperkalemia?

Hyperkalemia, with blood potassium levels greater than 5.5 mmol/L, commonly occurs due to decreased potassium excretion or abnormal potassium transport within cells, as well as other reasons such as excessive intake. Decreased potassium excretion can commonly be due to renal failure, the use of potassium-sparing diuretics, renal tubular acidosis, and reduced secretion of corticosteroid aldosterone. Abnormal potassium transport includes conditions such as acidosis, rhabdomyolysis, extensive burns, severe trauma, intestinal necrosis, and peritoneal bleeding, among other diseases. Excessive potassium intake can be due to sample hemolysis or an elevation in white blood cells, both of which can lead to hyperkalemia. Therefore, it is crucial to be vigilant in clinical settings and address the condition promptly and appropriately.

doctor image
home-news-image
Written by Luo Han Ying
Endocrinology
1min 12sec home-news-image

What should not be eaten with hyperkalemia?

Potassium is an important element in human blood. Typically, the electrolytes we measure in blood tests include sodium, potassium, chloride, and calcium. Both low and high levels of potassium can have adverse effects on the body, especially hyperkalemia, which can cause sudden cardiac arrest and is considered dangerous in clinical settings. Patients with normal kidney function are less likely to develop hyperkalemia, which is more commonly seen in those who may have consumed Chinese herbal medicines containing high amounts of potassium for a long time. In patients with renal insufficiency, due to impaired kidney excretory function, hyperkalemia occurs more easily. Patients with hyperkalemia should generally avoid ACE inhibitors and ARB medications. For example, drugs like ACE inhibitors and spironolactone can further exacerbate hyperkalemia, so these types of medications are definitely not advisable. (The use of medications should be under the guidance of a professional doctor.)

doctor image
home-news-image
Written by Yang Li
Endocrinology
51sec home-news-image

What medication is used for hyperkalemia?

Hyperkalemia is primarily treated by promoting diuresis to enhance the elimination of potassium, while calcium gluconate can also be administered intravenously to counteract the inhibitory effects of potassium on the heart. Additionally, concentrated glucose with insulin can be used to shift excess potassium ions from the blood. Sodium bicarbonate can also be used to alkalinize the blood's pH to help reduce potassium levels. All these treatments must be conducted safely. In cases of severe hyperkalemia, dialysis may be necessary. If arrhythmias, bradycardia, or myocardial depression occur, the installation of a temporary pacemaker, along with hemodialysis, may be required. (Medication should be administered under the guidance of a physician.)

doctor image
home-news-image
Written by Zhao Xin Lan
Endocrinology
56sec home-news-image

How should hyperkalemia be managed?

First, it is necessary to assess the severity of the hyperkalemia, whether it is mild, moderate, or severe. For mild hyperkalemia, it can be managed by taking oral diuretics or intravenous infusion of glucose with insulin, which can normalize the potassium level. In cases of severe hyperkalemia, where blood potassium exceeds 7.5 mmol/L, there is a risk of causing cardiac arrest. Emergency measures to promote potassium excretion are required, such as hemodialysis or peritoneal dialysis. It is also necessary to counteract the myocardial depressive effects of potassium, which can be managed with the injection of calcium gluconate, along with the intravenous infusion of hypertonic glucose and insulin. (The use of medications should be conducted under the guidance of a doctor.)