Hyperkalemia can be seen in which diseases?

Written by Wei Shi Liang
Intensive Care Unit
Updated on March 08, 2025
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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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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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Clinical manifestations of hyperkalemia

The clinical manifestations of hyperkalemia mainly affect the cardiovascular system, often presenting with slowed heart rate and various arrhythmias. When the blood potassium level is between 6.6 and 8.0 mmol/L, a tent-shaped T-wave can be observed. Rapid increases in blood potassium can lead to ventricular tachycardia, and even ventricular fibrillation. A gradual increase in blood potassium can cause conduction blocks, and in severe cases, cardiac arrest. Sudden death in severe hyperkalemia is mainly due to ventricular fibrillation and cardiac arrest. The second aspect is symptoms related to the neuromuscular system. As the concentration of potassium ions in the extracellular fluid increases, the resting membrane potential drops, leading to muscle weakness and even paralysis, typically more pronounced in the lower limbs and extending upward along the trunk. In severe cases, some patients may experience difficulty in swallowing and breathing difficulties. Symptoms involving the central nervous system mainly include restlessness, confusion, and fainting.

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Hyperkalemia

Typically, when serum potassium exceeds 5.5 mmol/L, it is referred to as hyperkalemia. However, an increase in serum potassium does not necessarily reflect an overall increase in body potassium; serum potassium can also rise when there is a deficiency of total body potassium. Therefore, in clinical practice, serum potassium is evaluated in conjunction with an electrocardiogram and medical history to determine if a patient has hyperkalemia. Hyperkalemia is an important emergency in internal medicine and can often lead to sudden cardiac arrest. It should be identified and prevented early.

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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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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.)