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February 10, 2012

Hyperkalemia (cont.)

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Potassium supplements, salt substitutes that contain potassium and other medications can cause hyperkalemia.

In normal individuals, healthy kidneys can adapt to excessive oral intake of potassium by increasing urine excretion of potassium, thus preventing the development of hyperkalemia. However, taking in too much potassium (either through foods, supplements, or salt substitutes containing potassium) can cause hyperkalemia if there is kidney dysfunction or if the patient is taking medications that decrease urine potassium excretion such as ACE inhibitors and potassium-sparing diuretics.

Examples of medications that decrease urine potassium excretion include:

Even though mild hyperkalemia is common with these medications, severe hyperkalemia usually do not occur unless these medications are given to patients with kidney dysfunction.

How is hyperkalemia diagnosed?

Blood is withdrawn from a vein (like other blood tests). The potassium concentration of the blood is determined in the laboratory. If hyperkalemia is suspected, an electrocardiogram (ECG or EKG) is often performed, since the ECG may show changes typical for hyperkalemia in moderate to severe cases. The ECG will also be able to identify cardiac arrhythmias that result from hyperkalemia.

How is hyperkalemia treated?

Treatment of hyperkalemia must be individualized based upon the underlying cause of the hyperkalemia, the severity of symptoms or appearance of ECG changes, and the overall health status of the patient. Mild hyperkalemia is usually treated without hospitalization especially if the patient is otherwise healthy, the ECG is normal, and there are no other associated conditions such as acidosis and worsening kidney function. Emergency treatment is necessary if hyperkalemia is severe and has caused changes in the ECG. Severe hyperkalemia is best treated in the hospital, oftentimes in the intensive care unit, under continuous heart rhythm monitoring.

Treatment of hyperkalemia may include any of the following measures, either singly or in combination:

  • A diet low in potassium (for mild cases).

  • Discontinue medications that increase blood potassium levels.

  • Intravenous administration of glucose and insulin, which promotes movement of potassium from the extracellular space back into the cells.

  • Intravenous calcium to temporarily protect the heart and muscles from the effects of hyperkalemia.

  • Sodium bicarbonate administration to counteract acidosis and to promote movement of potassium from the extracellular space back into the cells.

  • Diuretic administration to decrease the total potassium stores through increasing potassium excretion in the urine. It is important to note that most diuretics increase kidney excretion of potassium. Only the potassium-sparing diuretics mentioned above decrease kidney excretion of potassium.

  • Medications that stimulate beta-2 adrenergic receptors, such as albuterol and epinephrine, have also been used to drive potassium back into cells.

  • Medications known as cation-exchange resins, which bind potassium and lead to its excretion via the gastrointestinal tract.

  • Dialysis, particularly if other measures have failed or if renal failure is present.

Treatment of hyperkalemia naturally also includes treatment of any underlying causes (for example, kidney disease, adrenal disease, tissue destruction) of hyperkalemia.

Previous contributing author Dennis Lee, MD


Last Editorial Review: 3/7/2008


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