Hyperkalemia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Raviteja Guddeti, M.B.B.S. [3], Mahmoud Sakr, M.D. [4]

Overview

Hyperkalemia is an elevated blood level (above 5.1 mmol/L) of the electrolyte potassium. ". Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias. Hyperkalemia can be caused by reasons that include increased uptake, extracellular shift, tissue breakdown and impaired excretion from the body.

Causes

Life Threatening Causes

• Hyperkalemia can become a life-threatening condition if potassium levels are too high and body is not able to remove it effectively.
• AKI and chronic renal failure
• Addisonian crisis
• Diabetic ketoacidosis
• Intravenous potassium supplement
• Digoxin toxicity
• Tumor lysis syndrome

Common Causes

The most common causes of hyperkalemia include:

• ACE inhibitors
• Acidosis
• Addisonian crisis
• Beta blockers
• Blood transfusion
• Cirrhosis
• Diabetic nephropathy
• High potassium diet
• Malnutrition
• Renal tubular acidosis

Less common causes

• Fasting
• Exercise
• Fluoride toxicity
• Hypoparathyroidism

Genetic causes

• Congenital adrenal hypoplasia
• Hyperkalemic periodic paralysis
• Pseudohypoaldosteronism type1 and type 2

Causes by Organ System

Cardiovascular	Heart failure, volume depletion
Chemical / poisoning	Ammonium Bifluoride, arsenicals, fluoride toxicity, foxglove poisoning, oleander poisoning, tungsten, white chameleon poisoning
Dermatologic	No underlying causes
Drug Side Effect	ACE inhibitors, Acetaminophen and Oxycodone, acetylsalicylic Acid, aldosterone antagonists, amiloride, Amlodipine besylate and Valsartan, angiotensin receptor blockers, Basiliximab, beta blockers, Cefepime, Cefpodoxime, celecoxib, Cidofovir, cyclosporine, diazoxide, digoxin, Drospirenone and Ethinyl estradiol, eplerenone, epsilon amino caproic acid, (EACA), erythropoietin, heparin, ibuprofen, indomethacin, isoflurane, ketoprofen, low-molecular weight heparin, Lisinopril and Hydrochlorothiazide, mannitol, melarsoprol, methotrexate, minoxidil, naproxen, Nivolumab, Nilotinib, pancuronium bromide, pimecrolimus, potassium chloride, Potassium bicarbonate, potassium citrate, pomalidomide,propofol infusion syndrome, rifaximin, sodium thiopental, somatostatin therapy, spironolactone, succinylcholine, sulindac, suxamethonium, tacrolimus, thalidomide, triamterene, trimethoprim
Ear Nose Throat	No underlying causes
Endocrine	ACTH Deficiency, addisonian crisis, addison's disease, adrenal gland disorders, adrenal hyperplasia, congenital type 3, autoimmune adrenalitis, congenital adrenal hyperplasia -- sodium-wasting form, diabetes, diabetic ketoacidosis, hyperglycemia, hypoadrenocorticism -- hypoparathyroidism -- moniliasis, hyporeninemic hypoaldosteronism, isolated aldosterone synthase deficiency, lipoid congenital adrenal hyperplasia, pseudohypoaldosteronism type 1, pseudohypoaldosteronism type 2
Environmental	No underlying causes
Gastroenterologic	Cirrhosis, gastrointestinal bleeding
Genetic	18-Hydroxylase deficiency, congenital adrenal hyperplasia type 3, congenital adrenal hyperplasia -- sodium-wasting form, isolated aldosterone synthase deficiency, lipoid congenital adrenal hyperplasia, pseudohypoaldosteronism type 1, pseudohypoaldosteronism type 2
Hematologic	Hemolytic anemia, leukaemia, leukocytosis, sickle cell disease, thrombotic thrombocytopenic purpura
Iatrogenic	blood transfusion , cuffed blood sample, delayed separation blood sample, drip arm sample, EDTA blood sample, hemolysed blood sample, IV fluids containing potassium, using clenched fist while collection of blood
Infectious Disease	HIV infection
Musculoskeletal / Ortho	Muscle damage, muscle wasting
Neurologic	Amelo-cerebro-hypohidrotic syndrome, Kohlschutter-Tonz syndrome
Nutritional / Metabolic	hydrochloride Arginine, high Potassium diet, Malnutrition
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Acidosis, acute glomerulonephritis, acute renal failure, chronic interstitial nephritis, chronic renal failure, diabetic nephropathy, distal chloride shunt, distal renal tubular acidosis type IV, Gordon's syndrome, hemolytic uremic syndrome, hyperkalemic periodic paralysis, hyperkalemic Renal tubular acidosis, hypernatremia, hyperosmolality, hyperphosphataemia, lupus nephritis, obstructive uropathy, polycystic kidney disease, Familial pseudohyperkalemia-due to red cell leak, Distal renal tubular acidosis type 1, transplanted kidneys, tubulointerstitial disease, urinary tract obstruction, urolithiasis, hyporeninemic hypoaldosteronism, amyloidosis
Rheum / Immune / Allergy	systemic lupus erythematosus, autoimmune adrenalitis
Sexual	No underlying causes
Trauma	crush syndrome
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Amyloidosis - Renal, burns, dehydration, fasting, hypothermia, internal bleeding, intravenous infusion, malignant hyperpyrexia, phlebotomy complication, rhabdomyolysis, sea snake poisoning, selective impairment of potassium excretion, strenuous exercise, transplant rejection, tumor lysis syndrome, ureterojejunostomy

Causes in Alphabetical Order

Acidosis ACTH Deficiency Acute glomerulonephritis Acute renal failure Addisonian crisis Addison's disease Adrenal gland disorders Congenital adrenal hyperplasia due to 21-hydroxylase deficiency Aldosterone antagonists Amelo-cerebro-hypohidrotic syndrome Amiloride Ammonium Bifluoride Amyloidosis Angiotensin receptor blockers Arginine hydrochloride Arsenicals Autoimmune adrenalitis Beta blockers Blood transfusion Burns Celecoxib Cefepime Interstitial nephritis Chronic renal failure Cidofovir Cirrhosis Crush syndrome Cuffed blood sample Cyclosporine Dehydration Delayed separation blood sample Diabetes Diabetic ketoacidosis Diabetic nephropathy Diazoxide Digoxin Distal chloride shunt Drip arm sample EDTA blood sample Eplerenone Epsilon amino caproic acid (EACA) Erythropoietin Fasting Fluoride toxicity

Foxglove poisoning Gastrointestinal bleeding Gordon's syndrome Heart failure Hemolysed blood sample Hemolytic anemia Hemolytic uremic syndrome Heparin HIV infection Hyperglycemia Hyperkalemic periodic paralysis Hyperkalemic Renal tubular acidosis Hypernatremia Hyperosmolality Hyperphosphataemia Hypoadrenocorticism-- hypoparathyroidism -- moniliasis Hyporeninemic hypoaldosteronism Hypothermia Ibuprofen Indomethacin Internal bleeding Intravenous infusion Isoflurane Isolated aldosterone synthase deficiency IV fluids containing Potassium Ketoprofen Kohlschutter-Tonz syndrome Leukaemia Leukocytosis Lipoid congenital adrenal hyperplasia Lisinopril and Hydrochlorothiazide Low-molecular weight heparin Lupus nephritis Malignant hyperpyrexia Malnutrition Mannitol Melarsoprol Methotrexate Minoxidil Muscle damage Muscle wasting Naproxen Obstructive uropathy

Oleander Poisoning Oxalate blood sample Pancuronium bromide Phlebotomy complication Pimecrolimus Polycystic kidney disease Potassium chloride Potassium citrate Propofol infusion syndrome Pseudohyperkalemia familial, due to red cell leak Pseudohypoaldosteronism type 1 Pseudohypoaldosteronism type II Pyrimidifen Renal tubular acidosis, distal-type 1 Renal tubular acidosis, distal-type 4 Rhabdomyolysis Sea snake poisoning Selective impairment of potassium excretion Sickle cell disease Sodium thiopental Somatostatin therapy Spironolactone Strenuous exercise Succinylcholine Suxamethonium Systemic lupus erythematosus Tacrolimus Thrombotic thrombocytopenic purpura-congenital Thrombocytosis Transplant rejection Triamterene Trimethoprim Tubulointerstitial disease Tumor lysis syndrome Tungsten Ureterojejunostomy Urinary tract obstruction Urolithiasis Using clenched fist while collection of blood Volume depletion White Chameleon poisoning