Common Causes of Hyperkalemia

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 22, 2024
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Hyperkalemia is when the serum potassium concentration exceeds 5.5 millimoles per liter. Common causes include excessive potassium intake and large doses of potassium salts, which can lead to hyperkalemia, as well as the use of stored blood. Another cause is reduced potassium excretion; in patients with renal insufficiency, reduced urine output or anuria leads to decreased renal potassium excretion. If potassium supplementation is inappropriate at this time, or if potassium-sparing diuretics are used, severe hyperkalemia can occur. Another scenario is the leakage of intracellular potassium during respiratory and metabolic acidosis, where sodium ion exchange occurs in cells, hydrogen ions enter the cells, and potassium ions leak out to the extracellular space, which can lead to increased blood potassium. These are the common causes of hyperkalemia.

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Written by Chen Li Ping
Endocrinology
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The Impact of Hyperkalemia on the Heart

Typically, when serum potassium exceeds 5.5 mmol/L, it is referred to as hyperkalemia. The manifestations of hyperkalemia on the cardiovascular system usually include bradycardia and arrhythmias, but generally do not lead to congestive heart failure. Sometimes, there may be cardiac enlargement and diminished heart sounds, with characteristic changes on an electrocardiogram. Finally, when serum potassium reaches 12 mmol/L, some parts of the myocardium may be excited and recover, while others have not yet depolarized, making it very easy to cause tachycardia, flutter, ventricular fibrillation, and even cardiac arrest, leading to death. Therefore, hyperkalemia is also a major cause of sudden cardiac death. Some patients with hyperkalemia may only exhibit arrhythmias and show no neuromuscular symptoms before death, thus a rapid diagnosis is crucial. The severity of hyperkalemia is generally assessed by both the measured serum potassium concentration and changes in the electrocardiogram.

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Written by Wei Shi Liang
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The impact of hyperkalemia on the heart

The effects of hyperkalemia on the heart mainly manifest in the following ways: First, it affects the excitability of the myocardium, as hyperkalemia can cause reduced or even absent myocardial excitability; second, it impacts myocardial conductivity. In hyperkalemia, due to the reduced resting potential, the amplitude and speed of the action potential's phase zero decrease, leading to slowed excitability spread and reduced conductivity; third, it influences the automaticity of the myocardium. In hyperkalemia, due to slowed automatic depolarization, the automaticity is reduced. Additionally, hyperkalemia produces characteristic changes in the electrocardiogram, such as depression or disappearance of the P wave, prolongation of the PR interval, widening of the S wave, and narrowing and peaking of the T wave, which are the main changes in the electrocardiogram due to hyperkalemia.

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Why should calcium be supplemented for hyperkalemia?

When high potassium levels trigger ventricular automaticity, it is recommended to administer calcium to counteract its cardiotoxicity. This is because during hyperkalemia, the excitability of the myocardium significantly increases. Calcium ions do not affect the distribution of potassium inside and outside the cells, but they can stabilize the excitability of the heart. Therefore, even if a patient's blood calcium level is normal, calcium should be injected immediately when there is severe arrhythmia. Calcium ions only temporarily counteract the toxicity of potassium to the heart and do not reduce the concentration of potassium in the blood. Thus, they can only serve as a short-term emergency medication. (Medication should be used under the guidance of a doctor.)

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Written by Tang Zhuo
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Hyperkalemia is seen in which diseases?

When serum potassium levels exceed 5.5 millimoles per liter, it is referred to as hyperkalemia. Elevated serum potassium does not reflect an overall increase in body potassium, but due to limitations in testing methods, the clinical diagnosis of hyperkalemia still relies on combining serum potassium levels with electrocardiogram history. The causes of hyperkalemia are complex and commonly include: First, decreased renal potassium excretion, seen in acute kidney failure or insufficiency in adrenal cortical hormone synthesis and secretion, or long-term use of potassium-sparing diuretics; Second, shifts of potassium from inside the cells, often due to hemolysis, tissue damage, large-scale necrosis of tumors and inflammatory cells, shock, burns, excessive muscle contractions, acidosis, or injection of hypertonic saline or mannitol, which causes dehydration inside cells and leads to potassium leakage, resulting in hyperkalemia; Third, excessive intake of potassium-containing medications, such as high doses of potassium penicillin; Fourth, transfusion of stored blood can lead to hyperkalemia; Fifth, digitalis poisoning can cause hyperkalemia.

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Written by Wei Shi Liang
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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.