Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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Blood is withdrawn from a vein (like other blood tests).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.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
An arrhythmia is an abnormal heart rhythm. With an arrhythmia, the heartbeats may be irregular or too slow (bradycardia), to rapid (tachycardia), or too early. When a single heartbeat occurs earlier than normal, it is called a prmature contraction.
Addison disease is a hormonal (endocrine) disorder involving destruction of the adrenal glands (small glands adjacent to the kidneys). Diseased glands can no longer produce sufficient adrenal hormones (specifically cortisol) necessary for normal daily body functions. Symptoms include weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin. Treatment of Addison disease involves replacing, or substituting, the hormones that the adrenal glands are not making.
Potassium is an essential electrolyte necessary for cell function. Low potassium (hypokalemia) may be caused by diarrhea, vomiting, ileostomy, colon polyps, laxative use, diuretics, elevated corticosteroid levels, renal artery stenosis, and renal tubular acidosis, or other medications. Symptoms of low potassium include weakness, aches, and cramps of the muscles. Treatment is dependant upon the cause of the low potassium (hypokalemia).
Rhabdomyolysis is a rapid deterioration and destruction of skeletal muscle. Some of the causes of rhabdomyolysis include severe burns, muscle trauma, coma, seizures, electrolyte imbalance, medications (statins), viruses, bacteria. Treatment of rhabdomyolysis depends on the cause.
Burns are categorized by severity as first, second, or third degree. First degree burns are similar to a painful sunburn. The damage is more severe with second degree burns, leading to blistering and more intense pain. The skin turns white and loses sensation with third degree burns. Burn treatment depends upon the location, total burn area, and intensity of the burn.
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
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