Hyperkalemia diagnostic study of choice: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Created page with "__NOTOC__ {{Hyperkalemia }} {{CMG}}; {{AE}} == Overview == == Diagnostic Study of Choice == === Study of choice === [Name of the investigation] is the gold standard test...")
 
No edit summary
 
(33 intermediate revisions by 5 users not shown)
Line 3: Line 3:
{{Hyperkalemia }}
{{Hyperkalemia }}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{JSS}} {{SAH}}
 
== Overview ==
== Overview ==
Serum [[potassium]] is the gold standard test for the [[diagnosis]] of hyperkalemia. [[Pseudohyperkalemia]] needs to be ruled out whenever hyperkalemia is diagnosed. Pseudohyperkalemia is defined when serum [[potassium]] concentration exceeds that of plasma. Different etiologies of [[hyperkalemia]] can be assessed by using the [[Diagnosis|diagnostic]] criteria.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* Serum [[potassium]] is the gold standard test for the [[diagnosis]] of hyperkalemia.<ref name="pmid21181208">{{cite journal| author=Lehnhardt A, Kemper MJ| title=Pathogenesis, diagnosis and management of hyperkalemia. | journal=Pediatr Nephrol | year= 2011 | volume= 26 | issue= 3 | pages= 377-84 | pmid=21181208 | doi=10.1007/s00467-010-1699-3 | pmc=3061004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21181208  }} </ref><ref name="pmid17848395">{{cite journal| author=Crop MJ, Hoorn EJ, Lindemans J, Zietse R| title=Hypokalaemia and subsequent hyperkalaemia in hospitalized patients. | journal=Nephrol Dial Transplant | year= 2007 | volume= 22 | issue= 12 | pages= 3471-7 | pmid=17848395 | doi=10.1093/ndt/gfm471 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17848395  }} </ref>
 
OR
 
The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]
 
OR
 
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
 
OR
 
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR


There is no single diagnostic study of choice for the diagnosis of [disease name].  
*There are two methods to determine serum [[potassium]]:
**Ion-specific electrode (ISE) potentiometry
*ISE potentiometry has two different subtypes: direct (undiluted) and indirect (diluted).
**'''Direct ISE''' measures plasma [[potassium]] directly from a whole-blood sample and it's not associated with [[Pseudohyperkalemia|pseudohyperkalemia.]]
** FES or indirect ISE requires sample dilution before assay and both are associated with pseudohyperkalemia.


OR
=== Pseudohyperkalemia ===
* [[Pseudohyperkalemia]] is defined when serum [[potassium]] concentration exceeds that of plasma without any symptoms of hyperkalemia.


There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* It usually occurs when [[potassium]] moves out of cells during blood specimen collection or during [[centrifugation]] of the sample.
 
* Other causes are [[thrombocytosis]], [[leukocytosis]] and [[Polycythemia|erythrocytosis]].
OR
* To rule out pseudohyperkalemia we need to do the following :<ref name="pmid29472808">{{cite journal| author=Šálek T| title=Pseudohyperkalemia - Potassium released from cells due to clotting and centrifugation - a case report. | journal=Biochem Med (Zagreb) | year= 2018 | volume= 28 | issue= 1 | pages= 011002 | pmid=29472808 | doi=10.11613/BM.2018.011002 | pmc=5806620 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29472808  }} </ref>
 
** Repeat the blood sample.
[Disease name] is primarily diagnosed based on the clinical presentation.
**[[Complete blood count]] to rule out [[thrombocytosis]], [[erythrocytosis]] and [[leukocytosis]].
 
**Measurement of [[Blood plasma|plasma]] [[potassium]] and whole blood [[potassium]].
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>


===== Diagnostic results =====
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* Serum [[Potassium]] level more than 5.1 meq/L<ref name="pmid28778861">{{cite journal| author=Montford JR, Linas S| title=How Dangerous Is Hyperkalemia? | journal=J Am Soc Nephrol | year= 2017 | volume= 28 | issue= 11 | pages= 3155-3165 | pmid=28778861 | doi=10.1681/ASN.2016121344 | pmc=5661285 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28778861  }} </ref><ref name="pmid4625433">{{cite journal| author=Boddy K, King PC, Hume R, Weyers E| title=The relation of total body potassium to height, weight, and age in normal adults. | journal=J Clin Pathol | year= 1972 | volume= 25 | issue= 6 | pages= 512-7 | pmid=4625433 | doi= | pmc=477368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4625433  }} </ref>
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].


OR
== Common Diagnostic Studies ==
The serum [[potassium]] must be performed when:
* The [[patient]] presented with [[Cardiac arrhythmia|cardiac arrhythmias]], [[Muscle weakness|weakness]], [[fatigue]] and known case of [[Chronic renal failure|chronic kidney disease]]. The following investigations must be performed :
* Blood pressure(to look for [[hypoaldosteronism]])
* [[Complete blood count]]
* [[Renal function tests]]
* Urine [[potassium]],[[sodium]] and [[Osmolarity|osmolality]]
* Metabolic profile(other [[electrolytes]])
* [[The electrocardiogram|ECG]]
* [[Bicarbonate]] level
* Serum [[glucose]]
* Serum [[calcium]]


'''IF there are no established diagnostic criteria'''
Depending on the history and results of the above mentioned tests,other tests that can be performed for evaluating the cause of hyperkalemia <ref name="pmid7025622">{{cite journal| author=Adrogué HJ, Madias NE| title=Changes in plasma potassium concentration during acute acid-base disturbances. | journal=Am J Med | year= 1981 | volume= 71 | issue= 3 | pages= 456-67 | pmid=7025622 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7025622  }} </ref><ref name="pmid8589279">{{cite journal| author=Allon M| title=Hyperkalemia in end-stage renal disease: mechanisms and management. | journal=J Am Soc Nephrol | year= 1995 | volume= 6 | issue= 4 | pages= 1134-42 | pmid=8589279 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8589279  }} </ref>
* [[Digoxin]] level - If the [[patient]] is on a digitalis medication
*[[Arterial blood gases|Arterial]] or [[venous]] [[Arterial blood gas|blood gas]]
* Urinalysis
* Serum [[Cortisol|cortiso]]<nowiki/>l and [[aldosterone]] levels
* Serum [[uric acid]] and [[phosphorus]] assays
* Serum [[Creatine kinase|creatinine phosphokinase]] ([[CPK]]) measurements
* Urine [[myoglobin]] test


There are no established criteria for the diagnosis of [disease name].
=== Sequence of diagnostic studies ===
* Serum [[potassium]] measurement.
* [[ECG]]-it denotes the urgency of the treatment
* '''Renal function test.'''
**Serum [[Blood urea nitrogen|BUN]] and [[creatinine]] are measured
**Since [[creatinine]] levels are dependent on muscle mass so [[Glomerular filtration rate|GFR]] measurement is preferred
* '''Urine potassium, sodium and osmolality measurement.'''
**'''Urine potassium measurement.'''
***Urine [[potassium]] < 20meq/L denotes impaired excretion of potassium and denotes renal cause of hyperkalemia.
***Urine [[potassium]] 40meq/L denotes adequate excretion of [[potassium]] and excludes renal cause of hyperkalemia.
**'''Urine sodium''' < 20meq/L denotes decreased [[sodium]] delivery to the distal tubules which decreases potassium secretion.
**'''Urine osmolarity'''-measuring urine osmolarity is very important for accurate measurement of urine potassium as concenterated or dilute urine will alter the urine [[potassium]] concentration.
* '''Serum osmolarity'''
**High serum [[osmolarity]] (>295 mosm/kg) may result in extracellular shift of [[potassium]] <ref name="pmid76227">{{cite journal| author=Viberti GC| title=Glucose-induced hyperkalaemia: A hazard for diabetics? | journal=Lancet | year= 1978 | volume= 1 | issue= 8066 | pages= 690-1 | pmid=76227 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=76227  }} </ref><ref name="pmid3084904">{{cite journal| author=Adrogué HJ, Lederer ED, Suki WN, Eknoyan G| title=Determinants of plasma potassium levels in diabetic ketoacidosis. | journal=Medicine (Baltimore) | year= 1986 | volume= 65 | issue= 3 | pages= 163-72 | pmid=3084904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084904  }} </ref>
* Blood gas analysis: <ref name="pmid13242660">{{cite journal| author=SCRIBNER BH, FREMONT-SMITH K, BURNELL JM| title=The effect of acute respiratory acidosis on the internal equilibrium of potassium. | journal=J Clin Invest | year= 1955 | volume= 34 | issue= 8 | pages= 1276-85 | pmid=13242660 | doi=10.1172/JCI103174 | pmc=438696 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13242660  }} </ref>
**Decreased serum [[pH]] causes [[extracellular]] shift of [[potassium]] into the [[blood]]
* '''Transtubular potassium gradient''' <ref name="pmid18216310">{{cite journal| author=Choi MJ, Ziyadeh FN| title=The utility of the transtubular potassium gradient in the evaluation of hyperkalemia. | journal=J Am Soc Nephrol | year= 2008 | volume= 19 | issue= 3 | pages= 424-6 | pmid=18216310 | doi=10.1681/ASN.2007091017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18216310  }} </ref><ref name="pmid2321642">{{cite journal| author=Ethier JH, Kamel KS, Magner PO, Lemann J, Halperin ML| title=The transtubular potassium concentration in patients with hypokalemia and hyperkalemia. | journal=Am J Kidney Dis | year= 1990 | volume= 15 | issue= 4 | pages= 309-15 | pmid=2321642 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2321642  }} </ref>
**It calculates the ratio of amount [[potassium]] in the [[Collecting duct system|collecting duct]] of kidneys with the amount of [[potassium]] in the [[peritubular capillaries]]
**It indicates the activity of [[aldosterone]] on [[kidneys]] in regulation of [[potassium]] levels
**TTG calculation-( Urine K<sup>+</sup> x Serum [[osmolarity]])/(serum K<sup>+</sup> x Urine [[osmolarity]])
**TTG <3 suggests lack of [[aldosterone]] effect on [[Collecting duct system|collecting ducts]] causing decreased excretion of potassium
**TTG >7 suggest adequate effect of aldosterone in a case of hyperkalemia
**If TTG suggest [[aldosterone]] etiology then further testing done
*[[Aldosterone]] levels
*[[Renin]] levels <ref name="pmid2402122">{{cite journal| author=Conte G, Dal Canton A, Imperatore P, De Nicola L, Gigliotti G, Pisanti N et al.| title=Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure. | journal=Kidney Int | year= 1990 | volume= 38 | issue= 2 | pages= 301-7 | pmid=2402122 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2402122  }} </ref>
== Diagnostic criteria ==
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | A01 | | | | | | | | | | | |A01=Potassium >5.1meq/L}}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | B01 | | | | | | | | | | | B01= ECG }}
{{Family tree | | | | | | | | | | | | |,|-|^|-|.| | | | | | | | | | }}
{{Family tree | | | | | | | | | | | | C01 | | C02 | | | | | | | | | C01=If no changes,rule out [[pseudohyperkalemia]]| C02= If changes present then start urgent treatment}}
{{Family tree | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | | | | | |}}
{{Family tree | | | | | | | D01 | | | | | | | D02 |D01=Urine sodium <25 meq/L|D02=urine sodium >25 meq/L }}
{{Family tree | | | | | | | |!| | | |,|-|-|-|-|^|-|-|-|-|.| | | | | }}
{{Family tree | | | | | | | E01 | | E02 | | | | | | | | E03 | | | | | | | E01=ARF<br>CKD<br>[[Heart failure]],<br>Volume depletion|E02=Decreased K+secretion(Urine K+<20meq/L|E03=Transcellular shift(measure serum osmolarity and pH) }}
{{familytree  | | | | | | |,|-|-|-|-|^|-|-|.| | | | | | |!| | | | | | | | }}
{{Family tree | | | | | | F01 | | | | | | F02 | | | | | F03 | | | | | | F01=Low [[aldosterone]](TTG<3)|F02=Normal aldosterone(TTG>7)|F03=[[Diabetic ketoacidosis]],<br>Metabolic [[acidosis]]}}
{{Family tree | | | | |,|-|^|-|.| | | | | |!| | | | | | | | | | | }}
{{Family tree | | | | G01 | | G02 | | | | G03 | | | | | | | | | | G01=Low [[renin]]|G02=Normal renin|G03=Tissue breakdown,<br>[[Pseudohypoaldosternism]] type 1 and type 2,<br>Type 1 [[RTA]] }}
{{Family tree | | | | |!| | | |!| | | | | | | | | | | | }}
{{Family tree | | | | H01 | | H02 | | | | | | | | | H01=[[Interstital nephritis]],<br>[[Obstructive uropathies]],<br>[[Diabetic nephropathy]],<br>[[ACE inhibitors]],Angiotensin 2 receptors|H02=Primary [[hypoaldosteronism]],<br>[[Congenital adrenal hyperplasia]],<br>Aldosterone receptor antagonists,<br>RTA type 4
}}
{{familytree/end}}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}

Latest revision as of 22:32, 29 April 2020


Hyperkalemia Microchapters

Home

Patient information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hyperkalemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural history, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hyperkalemia diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hyperkalemia diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hyperkalemia diagnostic study of choice

CDC on Hyperkalemia diagnostic study of choice

Hyperkalemia diagnostic study of choice in the news

Blogs on Hyperkalemia diagnostic study of choice

Directions to Hospitals Treating Hyperkalemia

Risk calculators and risk factors for Hyperkalemia diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jogeet Singh Sekhon, M.D. [2] Syed Ahsan Hussain, M.D.[3]

Overview

Serum potassium is the gold standard test for the diagnosis of hyperkalemia. Pseudohyperkalemia needs to be ruled out whenever hyperkalemia is diagnosed. Pseudohyperkalemia is defined when serum potassium concentration exceeds that of plasma. Different etiologies of hyperkalemia can be assessed by using the diagnostic criteria.

Diagnostic Study of Choice

Study of choice

  • There are two methods to determine serum potassium:
    • Ion-specific electrode (ISE) potentiometry
  • ISE potentiometry has two different subtypes: direct (undiluted) and indirect (diluted).
    • Direct ISE measures plasma potassium directly from a whole-blood sample and it's not associated with pseudohyperkalemia.
    • FES or indirect ISE requires sample dilution before assay and both are associated with pseudohyperkalemia.

Pseudohyperkalemia

Diagnostic results

Common Diagnostic Studies

The serum potassium must be performed when:

Depending on the history and results of the above mentioned tests,other tests that can be performed for evaluating the cause of hyperkalemia [6][7]

Sequence of diagnostic studies

  • Serum potassium measurement.
  • ECG-it denotes the urgency of the treatment
  • Renal function test.
  • Urine potassium, sodium and osmolality measurement.
    • Urine potassium measurement.
      • Urine potassium < 20meq/L denotes impaired excretion of potassium and denotes renal cause of hyperkalemia.
      • Urine potassium 40meq/L denotes adequate excretion of potassium and excludes renal cause of hyperkalemia.
    • Urine sodium < 20meq/L denotes decreased sodium delivery to the distal tubules which decreases potassium secretion.
    • Urine osmolarity-measuring urine osmolarity is very important for accurate measurement of urine potassium as concenterated or dilute urine will alter the urine potassium concentration.
  • Serum osmolarity
  • Blood gas analysis: [10]
  • Transtubular potassium gradient [11][12]
  • Aldosterone levels
  • Renin levels [13]

Diagnostic criteria

 
 
 
 
 
 
 
 
 
 
 
 
 
Potassium >5.1meq/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ECG
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If no changes,rule out pseudohyperkalemia
 
If changes present then start urgent treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine sodium <25 meq/L
 
 
 
 
 
 
urine sodium >25 meq/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ARF
CKD
Heart failure,
Volume depletion
 
Decreased K+secretion(Urine K+<20meq/L
 
 
 
 
 
 
 
Transcellular shift(measure serum osmolarity and pH)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low aldosterone(TTG<3)
 
 
 
 
 
Normal aldosterone(TTG>7)
 
 
 
 
Diabetic ketoacidosis,
Metabolic acidosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low renin
 
Normal renin
 
 
 
Tissue breakdown,
Pseudohypoaldosternism type 1 and type 2,
Type 1 RTA
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Interstital nephritis,
Obstructive uropathies,
Diabetic nephropathy,
ACE inhibitors,Angiotensin 2 receptors
 
Primary hypoaldosteronism,
Congenital adrenal hyperplasia,
Aldosterone receptor antagonists,
RTA type 4
 
 
 
 
 
 
 
 

References

  1. ↑ Lehnhardt A, Kemper MJ (2011). "Pathogenesis, diagnosis and management of hyperkalemia". Pediatr Nephrol. 26 (3): 377–84. doi:10.1007/s00467-010-1699-3. PMC 3061004. PMID 21181208.
  2. ↑ Crop MJ, Hoorn EJ, Lindemans J, Zietse R (2007). "Hypokalaemia and subsequent hyperkalaemia in hospitalized patients". Nephrol Dial Transplant. 22 (12): 3471–7. doi:10.1093/ndt/gfm471. PMID 17848395.
  3. ↑ Šálek T (2018). "Pseudohyperkalemia - Potassium released from cells due to clotting and centrifugation - a case report". Biochem Med (Zagreb). 28 (1): 011002. doi:10.11613/BM.2018.011002. PMC 5806620. PMID 29472808.
  4. ↑ Montford JR, Linas S (2017). "How Dangerous Is Hyperkalemia?". J Am Soc Nephrol. 28 (11): 3155–3165. doi:10.1681/ASN.2016121344. PMC 5661285. PMID 28778861.
  5. ↑ Boddy K, King PC, Hume R, Weyers E (1972). "The relation of total body potassium to height, weight, and age in normal adults". J Clin Pathol. 25 (6): 512–7. PMC 477368. PMID 4625433.
  6. ↑ Adrogué HJ, Madias NE (1981). "Changes in plasma potassium concentration during acute acid-base disturbances". Am J Med. 71 (3): 456–67. PMID 7025622.
  7. ↑ Allon M (1995). "Hyperkalemia in end-stage renal disease: mechanisms and management". J Am Soc Nephrol. 6 (4): 1134–42. PMID 8589279.
  8. ↑ Viberti GC (1978). "Glucose-induced hyperkalaemia: A hazard for diabetics?". Lancet. 1 (8066): 690–1. PMID 76227.
  9. ↑ Adrogué HJ, Lederer ED, Suki WN, Eknoyan G (1986). "Determinants of plasma potassium levels in diabetic ketoacidosis". Medicine (Baltimore). 65 (3): 163–72. PMID 3084904.
  10. ↑ SCRIBNER BH, FREMONT-SMITH K, BURNELL JM (1955). "The effect of acute respiratory acidosis on the internal equilibrium of potassium". J Clin Invest. 34 (8): 1276–85. doi:10.1172/JCI103174. PMC 438696. PMID 13242660.
  11. ↑ Choi MJ, Ziyadeh FN (2008). "The utility of the transtubular potassium gradient in the evaluation of hyperkalemia". J Am Soc Nephrol. 19 (3): 424–6. doi:10.1681/ASN.2007091017. PMID 18216310.
  12. ↑ Ethier JH, Kamel KS, Magner PO, Lemann J, Halperin ML (1990). "The transtubular potassium concentration in patients with hypokalemia and hyperkalemia". Am J Kidney Dis. 15 (4): 309–15. PMID 2321642.
  13. ↑ Conte G, Dal Canton A, Imperatore P, De Nicola L, Gigliotti G, Pisanti N; et al. (1990). "Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure". Kidney Int. 38 (2): 301–7. PMID 2402122.
Retrieved from "https://www.wikidoc.org/index.php?title=Hyperkalemia_diagnostic_study_of_choice&oldid=1606629"