Custom Search

Algorithm for the diagnosis of Hyperkalemia

Causes of hyperkalemia:

* tight tourniquets and/or fist clenching
* small needle and/or venous sampling in a high vacuum tube
* over-vigorous centrifugation of the blood specimen and/or laboratory error
* red cell hemolysis
* thrombocytosis
* marked leucocytosis
* abnormal red cell membrane and potassium leakage

Excess potassium intake

* transfusion of old blood
* IV potassium administration
* KCl-containing salt substitutes
* Drugs containing potassium - IV penicillin, potassium citrate
* Unusual po sources - geophagia (clay soil), cautopyreiphagia (burnt match heads), black molasses

Redistributional or transcellular shifts

* cellular damage - burns, crush injury
* IV hemolysis
* tumor lysis
* rhabdomyolysis
* acidemia
* hypertonicity - mannitol, hyperglycemia
* medications - digoxin, somatostatin, succinylcholine, beta blockers
* severe physical exertion
* prematurity (first 72 hours of life)
* fasting in a dialysis patient
* toxins - palytoxin, tetrodotoxin, hydrofluouric acid, cocaine
* familial hyperkalemic periodic paralysis


* lack of renin substrate - very advanced liver failure
* hyporeninemia - diabetic nephropathy, interstitial nephritis, type IV RTA, drugs (NSIAD's, beta-blockers, heparin, cyclosporine)
* decreased aldosterone synthesis - congenital adrenal disease (21 hydroxylase enzyme deficiency and other specific synthetic defects) or acquired adrenal disease (Addison's disease, TB of the adrenals)
* absence or blockade of the aldosterone receptors - pseudohypoaldosteronemia type I, drugs (spironolactone,amiloride, triamterine, cyclosporine, trimethoprim, pentamidine)

Acute renal failure

Chronic renal failure

Urinary tract obstruction

Tubular defects in potassium secretion
* interstitial nephritis
* sickle cell disease
* diabetic nephropathy
* amyloidosis
* renal allograft
* drugs - sulfas, penicillin, rifampin, NSIAD's

Popular Posts