What are the symptoms of hyperkalemia?

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 02, 2024
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The effects of hyperkalemia on the body mainly include the following aspects:

First, the impact on muscle tissue: mild hyperkalemia can cause slight tremors in muscles. If the potassium levels continue to rise, this can lead to decreased neuromuscular excitability, resulting in limbs becoming weak and flaccid, and even leading to delayed paralysis.

Second, the impact on the cardiac system: it can cause a decrease in myocardial excitability, conductibility, and automaticity. The electrocardiogram shows a depressed P wave, widened QRS complex, shortened QT interval, and peaked T waves.

Third, hyperkalemia affects acid-base balance and can lead to metabolic acidosis during hyperkalemia.

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Written by Wei Shi Liang
Intensive Care Unit
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How to rescue hyperkalemia

Hyperkalemia must be dealt with immediately once it occurs. The usual treatments in clinical settings include promoting potassium excretion using furosemide or other loop diuretics to maximize renal potassium excretion, or using oral or rectal potassium-eliminating agents. For life-threatening hyperkalemia with serum potassium levels greater than 6.5 mmol/L, hemodialysis is necessary. Another approach is to facilitate the shift of potassium into cells, which is done through the administration of insulin with glucose, or sodium bicarbonate along with calcium gluconate that helps protect the myocardium, thus providing treatment and protective measures for hyperkalemia.

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Written by Wei Shi Liang
Intensive Care Unit
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Hyperkalemia can be seen in which diseases?

Hyperkalemia is a condition where the serum potassium concentration exceeds 5.5 millimoles per liter. Common causes include excessive intake of potassium, such as high-dose potassium penicillin intravenous infusion, ingestion of potassium-containing medications, or transfusion of large amounts of stored blood, all of which can lead to hyperkalemia. Additionally, patients with renal failure who experience oliguria or anuria may have reduced potassium excretion. In such cases, inappropriate potassium supplementation or the use of potassium-sparing diuretics can lead to severe hyperkalemia. Lastly, the movement of potassium from inside the cells—during metabolic acidosis and respiratory acidosis—causes ion exchange, leading to hydrogen ions entering the cells while potassium ions leak out, resulting in hyperkalemia.

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Written by Wei Shi Liang
Intensive Care Unit
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Common causes of hyperkalemia

Hyperkalemia is caused by increased intake or decreased excretion, or by the transfer of potassium ions from inside the cells to the outside. Increased intake generally does not cause hyperkalemia in individuals with normal kidney function, unless potassium is supplemented intravenously in excessive amounts or too quickly. Moreover, decreased excretion is a major cause of hyperkalemia, typically seen in renal failure, deficiency of adrenocortical hormones, and primary renal tubular disorders in potassium secretion. Additionally, a large transfer of potassium ions from inside the cells to the outside can occur in conditions such as massive cell breakdown, acidosis, tissue hypoxia, periodic paralysis, and insulin deficiency.

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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.)

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Can hyperkalemia be cured?

Hyperkalemia is treatable. The first cause of hyperkalemia is an excess of potassium, mainly seen in reduced renal excretion and excessive potassium intake, such as the infusion of a large volume of stored blood. In this case, diuretics can be used to increase the excretion of potassium. For cases of excessive potassium intake and excessive transfusion of stored blood, treatment options include diuresis and the use of glucose with insulin to lower potassium levels, or even treatment with sodium bicarbonate. In cases of shift hyperkalemia, primarily seen in hemolysis and septic shock, dialysis can be used to reduce hyperkalemia while simultaneously treating the underlying disease. The third type is concentration hyperkalemia and severe hemorrhagic shock, which causes a reduction in blood volume leading to blood concentration and relative hyperkalemia. Treatment of the primary disease first is advisable, and typically, the high blood potassium can self-correct after the primary disease is cured. There is also a condition known as pseudohyperkalemia, for example, prolonged storage of drawn blood can cause hemolysis within the tube, poor venipuncture technique, thrombocytosis, and leukocytosis can all lead to pseudo-hyperkalemia. In these cases, re-drawing blood multiple times to verify the potassium levels can address this issue. Therefore, hyperkalemia is treatable.