Hyperkalemia overview: Difference between revisions
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{{CMG}}; {{AE}} {{JSS}} {{SAH}} | {{CMG}}; {{AE}} {{JSS}} {{SAH}} | ||
==Overview== | ==Overview== | ||
[[Potassium]] was discovered in 1807 by Sir Humphry Davy in 1807 in England. He discovered [[potassium]] by means of [[electrolysis]] from [[potash]]. It was the first [[alkali]] metal to be discovered. [[Hyperkalemia]] develops when blood [[potassium]] levels are more than 5.1meq/L. Hyperkalemia can be classified based on the [[potassium]] levels, duration of onset and the cause of hyperkalemia. Potassium is the most abundant [[intracellular]] [[cation]] and is critically important for many [[physiologic]] processes. Hyperkalemia can be caused by reasons that include increased uptake, [[extracellular]] shift, [[Tissue (biology)|tissue]] breakdown and impaired [[excretion]] from the [[body]]. The [[incidence]] of hyperkalemia is approximately 11000 per 100,000 individuals in hospitalized and 1000-2000 per 100,000 of [[outpatients]].The exact [[prevalence]] of hyperkalemia is unknown. Extreme degrees of hyperkalemia are considered a [[medical emergency]]. If left untreated hyperkalemia can cause [[cardiac rhythm]] disorders and eventually [[Sudden cardiac death|cardiac arrest]] leading to death. Hyperkalemia can be [[asymptomatic]], or present with [[irregular heartbeat]], [[nausea]], slow, weak, or absent [[pulse]]. Serum [[potassium]] is the gold standard test for the [[diagnosis]] of hyperkalemia. When [[arrhythmias]] occur, or when [[potassium]] levels exceed 6.5 mmol/l, emergency lowering of [[potassium]] levels is mandated. Several agents are used to lower [[potassium]] levels. | |||
<br /> | <br /> | ||
==Historical Perspective== | ==Historical Perspective== | ||
[[Potassium]] was discovered in 1807 by Sir Humphry Davy in 1807 in England. He discovered [[potassium]] by means of [[electrolysis]] from [[potash]]. It was the first [[alkali]] metal to be discovered. | |||
<br /> | <br /> | ||
==Classification== | ==Classification== | ||
Hyperkalemia develops when blood [[potassium]] levels are more than 5.1meq/L. Hyperkalemia can be classified based on the [[potassium]] levels, duration of onset and the cause of hyperkalemia. | |||
==Pathophysiology== | ==Pathophysiology== | ||
Potassium is the most abundant [[intracellular]] [[cation]] and is critically important for many physiologic processes. The normal range of potassium in blood is 3.5-5.1mEq/L . Hyperkalemia develops when the level of potassium exceeds 5.5 meq/L in blood which can be due to an increase in intake of potassium, excessive production as seen in tissue breakdown, ineffective elimination of potassium or some drugs. The [[potassium]] levels in the body are highly regulated mainly by kidneys. The gut excretes a minimal amount of dietary potassium (approximately 10%) . Hyperkalemia is very common in patients with [[Chronic renal failure|chronic kidney disease]] as potassium is not effectively excreted from the bod y.Potassium is involved in maintaining transmembrane potentials of | [[Potassium]] is the most abundant [[intracellular]] [[cation]] and is critically important for many [[physiologic]] processes. The normal range of [[potassium]] in blood is 3.5-5.1mEq/L . Hyperkalemia develops when the level of [[potassium]] exceeds 5.5 meq/L in blood which can be due to an increase in intake of [[potassium]], excessive production as seen in tissue breakdown, ineffective elimination of [[potassium]] or some [[drugs]]. The [[potassium]] levels in the body are highly regulated mainly by [[kidneys]]. The [[gut]] excretes a minimal amount of dietary [[potassium]] (approximately 10%) . Hyperkalemia is very common in patients with [[Chronic renal failure|chronic kidney disease]] as [[potassium]] is not effectively excreted from the bod y.[[Potassium]] is involved in maintaining transmembrane potentials of cells, so [[imbalance]] in [[potassium]] levels can lead to [[disruption]] of [[cell membrane]] potentials and can cause hyperexcitablity leading to [[fatal]] [[Cardiac arrhythmia|cardiac arrhythmias]] and effecting [[nervous system]]. | ||
==Causes== | ==Causes== | ||
[[Hyperkalemia]] is an elevated [[blood]] level (above 5.1 mmol/L) of the [[electrolyte]] [[potassium]]. Hyperkalemia can be caused by reasons that include increased uptake, extracellular shift, tissue breakdown and impaired excretion from the body. | [[Hyperkalemia]] is an elevated [[blood]] level (above 5.1 mmol/L) of the [[electrolyte]] [[potassium]]. Hyperkalemia can be caused by reasons that include increased uptake, [[extracellular]] shift, [[tissue]] breakdown and impaired [[excretion]] from the [[body]]. | ||
==Differentiating Hyperkalemia from Other Diseases== | ==Differentiating Hyperkalemia from Other Diseases== | ||
Hyperkalemia is a laboratory finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia. | Hyperkalemia is a [[laboratory]] finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The incidence of hyperkalemia is approximately 11000 per 100,000 individuals in hospitalized and 1000-2000 per 100,000 of outpatients.The exact [[prevalence]] of hyperkalemia is unknown. It changes between inpatient and outpatient cases. In one study in USA, the prevalence was 1.57. Hypekalemia occurs more in females compared to males. It is more common in older age group. African American have higher chances of developing hyperkalemia compared to non-African-Americans. | The [[incidence]] of hyperkalemia is approximately 11000 per 100,000 individuals in hospitalized and 1000-2000 per 100,000 of [[outpatients]].The exact [[prevalence]] of hyperkalemia is unknown. It changes between [[inpatient]] and [[outpatient]] cases. In one study in USA, the [[prevalence]] was 1.57. Hypekalemia occurs more in [[females]] compared to [[males]]. It is more common in older age group. African American have higher chances of developing hyperkalemia compared to non-African-Americans. | ||
==Risk Factors== | ==Risk Factors== | ||
The [[kidneys]] normally remove excess potassium from the body. Most cases of [[hyperkalemia]] are caused by disorders that reduce the kidneys' ability to get rid of potassium. This may result from disorders such as [[acute kidney failure]], [[chronic kidney failure]] and [[glomerulonephritis]]. | The [[kidneys]] normally remove excess [[potassium]] from the [[body]]. Most cases of [[hyperkalemia]] are caused by disorders that reduce the [[kidneys]]' ability to get rid of [[potassium]]. This may result from disorders such as [[acute kidney failure]], [[chronic kidney failure]] and [[glomerulonephritis]]. | ||
==Screening== | ==Screening== | ||
There is insufficient evidence to recommend routine screening for hyperkalemia. However, potassium levels are routinely monitored in patients with [[Chronic renal failure|chronic kidney diseases]]. | There is insufficient [[evidence]] to recommend routine [[screening]] for hyperkalemia. However, [[potassium]] levels are routinely monitored in patients with [[Chronic renal failure|chronic kidney diseases]]. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
Extreme degrees of hyperkalemia are considered a medical emergency. If left untreated hyperkalemia can cause [[cardiac rhythm]] disorders and eventually [[Sudden cardiac death|cardiac arrest]] leading to death. Complications that can develop as a result of hyperkalemia are [[Cardiac arrhythmia|arrhythmia]], cardiac arrest, and neuromuscular weakness. The outcome with this condition varies. In some people, the disorder causes deadly complications, while others tolerate it well. | Extreme degrees of hyperkalemia are considered a [[medical emergency]]. If left untreated hyperkalemia can cause [[cardiac rhythm]] [[disorders]] and eventually [[Sudden cardiac death|cardiac arrest]] leading to death. [[Complications]] that can develop as a result of hyperkalemia are [[Cardiac arrhythmia|arrhythmia]], [[cardiac arrest]], and [[neuromuscular]] [[weakness]]. The outcome with this condition varies. In some people, the [[disorder]] causes deadly [[complications]], while others tolerate it well. | ||
== Diagnosis == | == Diagnosis == | ||
===Diagnostic Study of Choice=== | ===Diagnostic Study of Choice=== | ||
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. | Serum [[potassium]] is the [[Gold standard (test)|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. | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
Hyperkalemia often has no symptoms. Occasionally, people may have the following symptoms: irregular heartbeat, nausea, slow, weak, or absent pulse. Extreme degrees of hyperkalemia are considered a [[medical emergency]] due to the risk of potentially fatal [[Arrhythmia|arrhythmias]]. A detailed history taking is very helpful in diagnosing the cause of hyperkalemia. | Hyperkalemia often has no [[symptoms]]. Occasionally, people may have the following [[symptoms]]: [[irregular heartbeat]], [[nausea]], slow, weak, or absent [[pulse]]. Extreme degrees of hyperkalemia are considered a [[medical emergency]] due to the risk of potentially [[fatal]] [[Arrhythmia|arrhythmias]]. A detailed history taking is very helpful in diagnosing the cause of hyperkalemia. | ||
===Physical Examination=== | ===Physical Examination=== | ||
In patients with [[hyperkalemia]], physical examination may vary from normal to [[bradycardia]] ([[heart block]]), [[tachypnea]] due to respiratory muscle weakness and absent tendon reflexes. Evaluation of vital signs plays a key role in determining hemodynamic stability and identifying the presence of cardiac arrhythmias due to the hyperkalemia. | In [[patients]] with [[hyperkalemia]], [[physical examination]] may vary from normal to [[bradycardia]] ([[heart block]]), [[tachypnea]] due to [[respiratory]] muscle weakness and absent [[Tendon reflex|tendon reflexes]]. Evaluation of [[vital signs]] plays a key role in determining [[hemodynamic]] [[stability]] and identifying the presence of [[cardiac arrhythmias]] due to the hyperkalemia. | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
In a patient who does not have a risk for hyperkalemia, repeating the blood test is indicated before taking any actions unless changes are present on electrocardiography. | In a patient who does not have a risk for hyperkalemia, repeating the [[blood test]] is indicated before taking any actions unless changes are present on [[electrocardiography]]. | ||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
Extreme degrees of hyperkalemia are considered a [[medical emergency]] due to the risk of potentially fatal [[Arrhythmia|arrhythmias]]. The [[EKG]] is an important tool in evaluating a patient who has hyperkalemia as well as in diagnosing hyperkalemia. However, [[EKG]] changes do not always correlate with the degree of hyperkalemia. Some of the EKG changes that can be seen associated with hyperkalemia include [[peaked T waves]], PR interval prolongation, [[Wide QRS|QRS complex widening]], absence of [[P waves]], [[sine wave pattern]] and [[sinus arrest]]. | Extreme degrees of hyperkalemia are considered a [[medical emergency]] due to the risk of potentially [[fatal]] [[Arrhythmia|arrhythmias]]. The [[EKG]] is an important tool in evaluating a [[patient]] who has hyperkalemia as well as in [[Diagnosis|diagnosing]] hyperkalemia. However, [[EKG]] changes do not always correlate with the degree of hyperkalemia. Some of the [[EKG]] changes that can be seen associated with hyperkalemia include [[peaked T waves]], PR interval prolongation, [[Wide QRS|QRS complex widening]], absence of [[P waves]], [[sine wave pattern]] and [[sinus arrest]]. | ||
===X-ray=== | ===X-ray=== | ||
There are no x-ray findings associated with hyperkalemia. | There are no [[x-ray]] findings associated with hyperkalemia. | ||
===Echocardiography and Ultrasound=== | ===Echocardiography and Ultrasound=== | ||
There are no echocardiography/ultrasound findings associated with hyperkalemia. However depending on the cause of hyperkalemia ultrasound findings of the particular cause might be present. | There are no [[echocardiography]]/[[ultrasound]] findings associated with hyperkalemia. However depending on the cause of hyperkalemia [[ultrasound]] findings of the particular cause might be present. | ||
===CT scan=== | ===CT scan=== | ||
There are no CT scan findings associated with hyperkalemia. | There are no [[CT scan]] findings associated with hyperkalemia. | ||
===MRI=== | ===MRI=== | ||
There are no MRI findings associated with hyperkalemia | There are no [[MRI]] findings associated with hyperkalemia | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
There are no other imaging findings associated with hyperkalemia | There are no other [[imaging]] findings associated with hyperkalemia | ||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
There are no other diagnostic studies associated with hyperkalemia | There are no other [[diagnostic]] studies associated with hyperkalemia | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
When arrhythmias occur, or when potassium levels exceed 6.5 mmol/l, emergency lowering of potassium levels is mandated. Several agents are used to lower | When [[arrhythmias]] occur, or when [[potassium]] levels exceed 6.5 mmol/l, [[emergency]] lowering of [[potassium]] levels is mandated. Several agents are used to lower <sub>-p6</sub> levels. Choice depends on the degree and cause of the hyperkalemia, and other aspects of the [[Patient|patient's]] condition. | ||
===Surgery=== | ===Surgery=== | ||
Surgical intervention is not recommended for the management of hyperkalemia. | [[Surgical]] intervention is not recommended for the management of hyperkalemia. | ||
===Primary Prevention=== | ===Primary Prevention=== | ||
Hyperkalemia can be prevented by limiting the intake of potassium in diet and avoiding renal damage. | Hyperkalemia can be prevented by limiting the intake of [[potassium]] in diet and avoiding [[renal]] damage. | ||
===Secondary Prevention=== | ===Secondary Prevention=== | ||
Stabilizing the heart membrane in [[hyperkalemia]] is very important in preventing fatal [[Cardiac arrhythmia|cardiac arrhythmias]].Effective elimination of potassium from the body also prevents complications. | Stabilizing the [[heart]] membrane in [[hyperkalemia]] is very important in preventing [[fatal]] [[Cardiac arrhythmia|cardiac arrhythmias]]. Effective elimination of [[potassium]] from the [[body]] also prevents [[complications]]. | ||
==References== | ==References== | ||
Latest revision as of 04:55, 23 April 2020
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
Potassium was discovered in 1807 by Sir Humphry Davy in 1807 in England. He discovered potassium by means of electrolysis from potash. It was the first alkali metal to be discovered. Hyperkalemia develops when blood potassium levels are more than 5.1meq/L. Hyperkalemia can be classified based on the potassium levels, duration of onset and the cause of hyperkalemia. Potassium is the most abundant intracellular cation and is critically important for many physiologic processes. Hyperkalemia can be caused by reasons that include increased uptake, extracellular shift, tissue breakdown and impaired excretion from the body. The incidence of hyperkalemia is approximately 11000 per 100,000 individuals in hospitalized and 1000-2000 per 100,000 of outpatients.The exact prevalence of hyperkalemia is unknown. Extreme degrees of hyperkalemia are considered a medical emergency. If left untreated hyperkalemia can cause cardiac rhythm disorders and eventually cardiac arrest leading to death. Hyperkalemia can be asymptomatic, or present with irregular heartbeat, nausea, slow, weak, or absent pulse. Serum potassium is the gold standard test for the diagnosis of hyperkalemia. When arrhythmias occur, or when potassium levels exceed 6.5 mmol/l, emergency lowering of potassium levels is mandated. Several agents are used to lower potassium levels.
Historical Perspective
Potassium was discovered in 1807 by Sir Humphry Davy in 1807 in England. He discovered potassium by means of electrolysis from potash. It was the first alkali metal to be discovered.
Classification
Hyperkalemia develops when blood potassium levels are more than 5.1meq/L. Hyperkalemia can be classified based on the potassium levels, duration of onset and the cause of hyperkalemia.
Pathophysiology
Potassium is the most abundant intracellular cation and is critically important for many physiologic processes. The normal range of potassium in blood is 3.5-5.1mEq/L . Hyperkalemia develops when the level of potassium exceeds 5.5 meq/L in blood which can be due to an increase in intake of potassium, excessive production as seen in tissue breakdown, ineffective elimination of potassium or some drugs. The potassium levels in the body are highly regulated mainly by kidneys. The gut excretes a minimal amount of dietary potassium (approximately 10%) . Hyperkalemia is very common in patients with chronic kidney disease as potassium is not effectively excreted from the bod y.Potassium is involved in maintaining transmembrane potentials of cells, so imbalance in potassium levels can lead to disruption of cell membrane potentials and can cause hyperexcitablity leading to fatal cardiac arrhythmias and effecting nervous system.
Causes
Hyperkalemia is an elevated blood level (above 5.1 mmol/L) of the electrolyte potassium. Hyperkalemia can be caused by reasons that include increased uptake, extracellular shift, tissue breakdown and impaired excretion from the body.
Differentiating Hyperkalemia from Other Diseases
Hyperkalemia is a laboratory finding that is a result of several conditions. These conditions must be differentiated as a cause of hyperkalemia.
Epidemiology and Demographics
The incidence of hyperkalemia is approximately 11000 per 100,000 individuals in hospitalized and 1000-2000 per 100,000 of outpatients.The exact prevalence of hyperkalemia is unknown. It changes between inpatient and outpatient cases. In one study in USA, the prevalence was 1.57. Hypekalemia occurs more in females compared to males. It is more common in older age group. African American have higher chances of developing hyperkalemia compared to non-African-Americans.
Risk Factors
The kidneys normally remove excess potassium from the body. Most cases of hyperkalemia are caused by disorders that reduce the kidneys' ability to get rid of potassium. This may result from disorders such as acute kidney failure, chronic kidney failure and glomerulonephritis.
Screening
There is insufficient evidence to recommend routine screening for hyperkalemia. However, potassium levels are routinely monitored in patients with chronic kidney diseases.
Natural History, Complications, and Prognosis
Extreme degrees of hyperkalemia are considered a medical emergency. If left untreated hyperkalemia can cause cardiac rhythm disorders and eventually cardiac arrest leading to death. Complications that can develop as a result of hyperkalemia are arrhythmia, cardiac arrest, and neuromuscular weakness. The outcome with this condition varies. In some people, the disorder causes deadly complications, while others tolerate it well.
Diagnosis
Diagnostic Study of Choice
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.
History and Symptoms
Hyperkalemia often has no symptoms. Occasionally, people may have the following symptoms: irregular heartbeat, nausea, slow, weak, or absent pulse. Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias. A detailed history taking is very helpful in diagnosing the cause of hyperkalemia.
Physical Examination
In patients with hyperkalemia, physical examination may vary from normal to bradycardia (heart block), tachypnea due to respiratory muscle weakness and absent tendon reflexes. Evaluation of vital signs plays a key role in determining hemodynamic stability and identifying the presence of cardiac arrhythmias due to the hyperkalemia.
Laboratory Findings
In a patient who does not have a risk for hyperkalemia, repeating the blood test is indicated before taking any actions unless changes are present on electrocardiography.
Electrocardiogram
Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias. The EKG is an important tool in evaluating a patient who has hyperkalemia as well as in diagnosing hyperkalemia. However, EKG changes do not always correlate with the degree of hyperkalemia. Some of the EKG changes that can be seen associated with hyperkalemia include peaked T waves, PR interval prolongation, QRS complex widening, absence of P waves, sine wave pattern and sinus arrest.
X-ray
There are no x-ray findings associated with hyperkalemia.
Echocardiography and Ultrasound
There are no echocardiography/ultrasound findings associated with hyperkalemia. However depending on the cause of hyperkalemia ultrasound findings of the particular cause might be present.
CT scan
There are no CT scan findings associated with hyperkalemia.
MRI
There are no MRI findings associated with hyperkalemia
Other Imaging Findings
There are no other imaging findings associated with hyperkalemia
Other Diagnostic Studies
There are no other diagnostic studies associated with hyperkalemia
Treatment
Medical Therapy
When arrhythmias occur, or when potassium levels exceed 6.5 mmol/l, emergency lowering of potassium levels is mandated. Several agents are used to lower -p6 levels. Choice depends on the degree and cause of the hyperkalemia, and other aspects of the patient's condition.
Surgery
Surgical intervention is not recommended for the management of hyperkalemia.
Primary Prevention
Hyperkalemia can be prevented by limiting the intake of potassium in diet and avoiding renal damage.
Secondary Prevention
Stabilizing the heart membrane in hyperkalemia is very important in preventing fatal cardiac arrhythmias. Effective elimination of potassium from the body also prevents complications.