Medical Intelligence from The New England Journal of Medicine — VI. Hyperkalemia. Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds mmol/l. It can be caused by reduced renal excretion, excessive. n engl j med ;3 january 15, mmol per liter.1,2 Hyperkalemia is defined as erate hyperkalemia) and more than mmol per.

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Absorption of potassium from the gastrointestinal tract is rapid and usually complete. Life-threatening hyperkalemia and acidosis secondary to trimethoprim-sulfamethoxazole treatment. Effect of vasopressin analogue dDAVP on potassium transport in medullary hyperjalemia duct. The best characterized is the Na-K-2Cl cotransporter NKCC2which transports potassium out of the tubular fluid and is inhibited by loop diuretics furosemide.

Renal replacement therapy RRT is the ultimate measure in severe hyperkalemia. Sodium channelopathies of skeletal muscle result from gain or loss of function. Hypoaldosteronism may either be primary e. Human cortical distal nephron: Symptoms are non-specific and predominantly related to muscular or cardiac dysfunction.

Margassery S, Bastani B.

Pathogenesis, diagnosis and management of hyperkalemia

Handling of potassium in the nephron depends on passive and active mechanisms. Mineral acidosis is more likely to cause a shift of potassium from intracellular space into extracellular space than organic acidosis. Additionally, if unknown, the cause of hyperkalemia has to be determined to prevent future episodes. Pseudohypoaldosteronism PHA refers to a heterogeneous group of disorders of electrolyte metabolism characterized by hyperkalemia, metabolic acidosis, and normal GRF [ 18 ].


Pediatric Nephrology Berlin, Germany. Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure.

Curr Opin Nephrol Hypertens. Congenital adrenal hyperplasia CAH: Pathogenesis of hyperkalemia Hyperkalemia may result from an increase in total body potassium secondary to imbalance of intake vs.

Pathogenesis, diagnosis and management of hyperkalemia

Ion-exchange resins containing calcium or sodium aim to keep enteral potassium from being resorbed. Severe hyperkalemia with minimal electrocardiographic manifestations: Please review our privacy policy.

Management should nrjm only rely on ECG changes but be guided by the clinical scenario and serial potassium measurements [ 2931 ]. It should be noted, however, that reabsorption and secretion of potassium occur simultaneously, and that many modulators are important, such as diet, adrenal steroids, and acid-base balance.

Potassium is filtered in the glomerulus and almost completely reabsorbed in the proximal tubule and the loop of Henle.

Which drug does not cause hyperkalemia? PHA type I secondary to loss of function mutations of the ENaC not only affects the kidney but also the lungs, colon, and sweat and salivary glands.

Increased shift of potassium from intra to extracellular space Acidosis: Succinylcholine, especially when given to patients with burn injuries, immobilization, or inflammation [ 26 ].


Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds 5. Low extracellular potassium concentrations of 3. Salbutamol ten drops of standard sabutamol inhalation solution contain 2.

This article reviews the pathomechanisms leading to hyperkalemic states, its symptoms, and different treatment options.

Hyperkalemia nsjm rarely associated with symptoms, occasionally patients complain of palpitations, nausea, muscle pain, or paresthesia.

Hyperkalemia, congestive heart failure, and aldosterone receptor antagonism. Correction factors have been discussed, but blood usually has to be drawn again [ 30 ]. Even in chronic hemodialysis patients, treatment with loop diuretics may be of value if the patient has some residual renal function [ 36 ]. In treatment of moderate to severe hyperkalemia, the combination of medications with different therapeutic approaches is usually effective, and often methods of blood purification can be avoided.

A similar picture can be seen in patients with obstructive uropathy and renal tubular acidosis [ 1617 ]. Acute increase in osmolality secondary to hyperglycemia or mannitol infusion causes potassium to exit from cells [ 24 ].

Aldosterone and potassium secretion by the cortical collecting duct.