What are the causes of hyperkalemia?

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

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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.)

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Can hyperkalemia be cured?

The main focus is on the cause of hyperkalemia. If hyperkalemia is due to consuming foods rich in potassium, administration of potassium-containing solutions, transfusion of stored blood, use of potassium-sparing diuretics like spironolactone, or prolonged venipuncture causing severe shaking of the blood sample during transport, addressing these causes can prevent the occurrence of hyperkalemia. If hyperkalemia is caused by certain diseases, such as renal failure or adrenal insufficiency, active treatment of the underlying disease is required. If the renal failure is acute, recovery of kidney function might prevent the recurrence of hyperkalemia. However, if there is chronic renal insufficiency, there tends to be a higher recurrence rate of hyperkalemia. Therefore, whether hyperkalemia can be cured largely depends on identifying the underlying cause.

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Is hyperkalemia acidosis?

Hyperkalemia is not acidosis, but during acidosis, the hydrogen ions of the gastric fluid within cells enter the cells, causing the potassium ions inside the cells to move to the extracellular fluid, resulting in hyperkalemia. Clinically, it is commonly seen in organic acidosis, lactic acidosis, diabetic ketoacidosis, and acute renal failure causing acidosis. Once hyperkalemia occurs and is diagnosed, immediate treatment should be administered. First, the primary disease should be treated; next, serum potassium should be reduced. In particularly severe cases, bedside hemofiltration can be administered, and the cardiotoxic effects of hyperkalemia should be mitigated.

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What kind of urine occurs with hyperkalemia?

Primary hyperkalemia often coincides with metabolic acidosis, and in hyperkalemia-induced metabolic acidosis, paradoxical alkaline urine can occur. Once hyperkalemia occurs, it primarily affects the conduction of the heart and neuromuscular system. Typical clinical manifestations include severe bradycardia, atrioventricular conduction block, and even sinus arrest. In mild hyperkalemia, the electrocardiogram shows peaked T-waves; as potassium levels continue to rise, the PR interval prolongs, T-waves disappear, QRS complex widens, and ultimately, cardiac arrest occurs. Immediate treatment should be administered upon diagnosis to promote the excretion of potassium, maximizing the renal excretion capacity with diuretics. If drug-induced potassium excretion does not normalize levels and serum potassium exceeds 6.5 mmol/L, hemodialysis may be necessary. Additionally, some drugs can be used to shift potassium into the cells and protect cardiac function. (The use of any medication should be under the guidance of a doctor.)

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How is hyperkalemia treated?

Hyperkalemia must be handled immediately after it occurs, otherwise it can cause malignant arrhythmias and even endanger life. The first step is to stop potassium supplements, such as potassium chloride sustained-release tablets; the second step is to stop potassium-sparing diuretics, such as spironolactone and other drugs. We can administer calcium intravenously to antagonize the toxic effects of high potassium on the heart. Additionally, we can use high glucose with insulin and intravenously drip sodium bicarbonate, which can promote the movement of potassium into cells. We can also use diuretics to excrete potassium through urine. If the treatment effect is poor after medication, we can use bedside hemodialysis to reduce blood potassium.