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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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.

Pathogenesis, diagnosis and management of hyperkalemia

Succinylcholine, especially when given to patients with burn injuries, immobilization, or inflammation [ 26 ]. Hyperkalemia is rarely associated with symptoms, occasionally patients complain of palpitations, nausea, muscle pain, or paresthesia. Salbutamol ten drops of standard sabutamol inhalation solution contain 2.

In hemodialysis patients with hyperkalemia it has only a moderate effect if given as prolonged infusion [ 35 ]. Therapeutic strategies should be individualized, taking into account the degree and the cause of hyperkalemia.

Knowledge of the physiological mechanisms of potassium handling is essential in understanding the causes of hyperkalemia as well as its treatment. Additionally, if unknown, the cause of hyperkalemia has to be determined to prevent hyperka,emia episodes.


Effective treatment of acute hyperkalaemia in childhood by short-term infusion of salbutamol. Hyperkalemia, Potassium, Renal failure, Salbutamol. Sustained-release potassium chloride overdose.

Especially when capillary samples are taken, excess alcohol on the skin should be avoided, as it is the primary cause of the hemolysis in this process. Huang C, Miller RT. Addison or secondary e. This results from leakage of potassium from the intracellular space hyperkalemiia or after blood sampling. Basolateral transporters include a KCl cotransporter.

Continuous hyoerkalemia hemofiltration CVVH can more satisfactorily provide long-term control of potassium. Leakage of potassium out of cells through depolarization of cell membranes. Anja Lehnhardt and Markus J.

hyperrkalemia Weir MR, Rolfe M. More effective if given orally. Renal tubular handling of potassium in children with insulin-dependent diabetes mellitus.

Pseudohyperkalemia If elevated serum potassium is found in an asymptomatic patient with no apparent cause, factitious hyperkalemia should be considered. This article reviews the pathomechanisms leading to hyperkalemic states, its symptoms, and different treatment options. Aldosterone as key regulator of renal potassium homeostasis binds to the nuclear mineralocorticoid receptor MR within the distal tubule and the principal cells in the CCD.

Effect of vasopressin analogue dDAVP on potassium transport in medullary collecting duct.

Pathogenesis, diagnosis and management of hyperkalemia

Abstract Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds 5. Hyperkalemia can be classified according to serum potassium into mild 5. Especially in pediatrics, mechanical hemolysis can occur during difficult blood draws, and even more in samples with lymphocytosis or thrombocytosis.


Sodium bicarbonate, preferably given to patients who are acidotic. A similar picture can be seen in patients with obstructive uropathy and renal tubular acidosis [ 1617 ].

Hyperkalemia, congestive heart failure, and aldosterone receptor antagonism. Acute increase hhperkalemia osmolality secondary to hyperglycemia or mannitol infusion causes potassium to exit from cells [ 24 ]. Handling of potassium in the nephron depends on passive and active mechanisms.

In these cases, elevation of serum potassium concentration does not reflect the level of serum potassium in vivo and no treatment is needed. Management should not only rely on ECG changes hyperkalemiw be guided by the clinical scenario and serial potassium measurements [ 2931 ].

Used with permission from [ 40 ] RTA renal tubular acidosis. Renal and gastrointestinal potassium excretion in humans: