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Hyperkalemia – Causes, Symptoms and Treatment
Hyperkalemia refers to an elevated potassium level in the blood. It can cause dangerous heart rhythm disturbances and requires prompt medical attention.
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Hyperkalemia refers to an elevated potassium level in the blood. It can cause dangerous heart rhythm disturbances and requires prompt medical attention.
What is Hyperkalemia?
Hyperkalemia is an electrolyte disorder in which the concentration of potassium in the blood rises above 5.0 mmol/l. Potassium is an essential mineral that plays a critical role in the function of heart and skeletal muscle cells, as well as in the transmission of nerve impulses. Elevated potassium levels disrupt these electrical processes and can have life-threatening consequences.
Causes
Hyperkalemia can result from various diseases, medications, or external factors:
- Kidney failure: The most common cause. Impaired kidneys cannot adequately excrete potassium.
- Medications: ACE inhibitors, angiotensin receptor blockers (ARBs), potassium-sparing diuretics (e.g., spironolactone), NSAIDs, and certain antibiotics can raise potassium levels.
- Addison disease: A deficiency of aldosterone leads to reduced potassium excretion by the kidneys.
- Tissue breakdown (rhabdomyolysis, hemolysis, tumor lysis syndrome): Damaged cells release large amounts of intracellular potassium into the bloodstream.
- Excessive potassium intake: Through diet or intravenous infusions, especially in patients with impaired kidney function.
- Metabolic acidosis: Shifts potassium from inside cells into the bloodstream.
- Pseudohyperkalemia: A laboratory artifact caused by hemolysis of the blood sample, producing a falsely elevated result.
Symptoms
Mild hyperkalemia is often asymptomatic. At higher levels, the following symptoms may occur:
- Muscle weakness, fatigue, and paralysis
- Tingling or numbness (paresthesia)
- Nausea and abdominal cramps
- Heart rhythm disturbances (palpitations, bradycardia)
- In severe cases: cardiac arrest (ventricular fibrillation)
Diagnosis
Diagnosis is made through a blood test measuring serum potassium levels. An ECG (electrocardiogram) is also performed to detect potentially dangerous cardiac changes early. Typical ECG findings in hyperkalemia include tall, peaked T-waves, a prolonged PR interval, widened QRS complexes, and in severe cases, a sine-wave pattern. Kidney function tests (creatinine, urea), blood gas analysis, and other relevant laboratory parameters are also assessed.
Severity Grades
- Mild: 5.1 – 5.9 mmol/l
- Moderate: 6.0 – 6.4 mmol/l
- Severe: ≥ 6.5 mmol/l (life-threatening)
Treatment
Treatment depends on the severity and the underlying cause:
Acute Interventions
- Intravenous calcium gluconate: Immediately stabilizes cardiac muscle cells but does not lower potassium levels.
- Insulin and glucose intravenously: Rapidly shifts potassium back into cells.
- Sodium bicarbonate: Used in cases of concurrent acidosis to promote cellular potassium uptake.
- Beta-2 agonists (e.g., salbutamol): Administered by inhalation or intravenously to shift potassium into cells.
Potassium Elimination
- Loop diuretics (e.g., furosemide): Increase renal potassium excretion.
- Potassium binders (e.g., patiromer, sodium zirconium cyclosilicate): Bind potassium in the intestine, allowing it to be excreted through stool.
- Hemodialysis: Indicated for severe, life-threatening hyperkalemia or when other treatments fail.
Long-Term Management
- Low-potassium diet (limiting bananas, potatoes, legumes, and nuts)
- Adjusting or discontinuing medications that raise potassium levels
- Treating the underlying condition (e.g., chronic kidney disease)
References
- Weir MR, Bakris GL et al. - Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. New England Journal of Medicine, 2015.
- Palmer BF, Clegg DJ - Diagnosis and Treatment of Hyperkalemia. Cleveland Clinic Journal of Medicine, 2017; 84(12): 934–942.
- World Health Organization (WHO) - Cardiovascular Diseases and Electrolyte Disorders: Clinical Guidelines. WHO Press, Geneva.
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