Hyperkalemia (cont.)
Medications
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:
- ACE inhibitors,
- ARBs,
- NSAIDs,
- potassium-sparing diuretics such as:
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Blood is withdrawn from a vein (like other blood tests).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.
Last Editorial Review: 3/7/2008
Next: What are the symptoms of hyperkalemia? »
- ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
- Electrolytes - Read about blood electrolytes (sodium, potassium, chloride, and bicorbonate) and the effects of electrolyte imbalances like kidney failure, low blood pressure, hypokalemia, and hyperkalemia.
- Kidney Failure - Learn about kidney failure, in which the body has fluid retention, risen blood pressure, toxin build up and lack of red blood cells. Symptoms include fatigue, nausea, and apetite loss.
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