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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Diagnostic hyperkalemi in hyperkalemia; adapted from Clinical Paediatric Nephrology. Acute increase in osmolality secondary to hyperglycemia or mannitol infusion causes potassium to exit from cells [ 24 ]. Potassium is filtered in the glomerulus and almost completely reabsorbed in the proximal tubule and the loop of Henle.

Basolateral transporters include a KCl cotransporter. Hyperkalemia can be classified according to serum potassium into mild 5. Pediatric Nephrology Berlin, Germany. Continuous veno-venous hemofiltration CVVH can more satisfactorily provide long-term control of potassium.

Pathogenesis, diagnosis and management of hyperkalemia

This article reviews the pathomechanisms leading to hyperkalemic states, its symptoms, and different treatment options. Salbutamol has been shown to be safe and even superior to rectal cation-exchange resin in nonoliguric preterms with hyperkalemia [ 34 ]. PHA type I caused by autosomal dominant mutations in the human mineralocorticoid receptor MR gene is limited to the kidneys.

Excretion mainly occurs in the cortical collecting duct [ 2 ]. J Am Soc Nephrol. Effective treatment of acute hyperkalaemia in childhood hyperkaleima short-term infusion hyperkkalemia salbutamol.


Treatment has to be more aggressive the higher and the faster the rise of the potassium level, and the greater the evidence of toxicity ECG changes.

This results from leakage of potassium from the intracellular space during or after blood sampling. If elevated serum potassium is found in an asymptomatic patient with no apparent cause, factitious hyperkalemia hyperkale,ia be considered.

This article has been cited by other articles in PMC. Additionally, if unknown, the cause of hyperkalemia has to be determined to prevent future episodes. J Toxicol Clin Toxicol. Martyn JA, Richtsfeld M.

In patients with unimpaired renal function and intact other regulatory mechanisms, large amounts of potassium are needed to achieve hyperkalemia [ 11 ]. Palmer LG, Frindt G. Diarrhea if preparations come premixed with sorbitol p. Renal mechanisms of potassium handling Handling of potassium in the nephron depends on passive and active mechanisms.

Increased shift of potassium from intra to extracellular space Acidosis: Hyperkalemiq factors have been discussed, but blood usually has to be drawn again [ 30 ].

Curr Opin Nephrol Hypertens. Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure. Diarrhea if preparations come premixed with sorbitol. Diagnosis of hyperkalemia Hyperkalemia can be classified according to serum potassium into mild 5. A similar picture can be seen in patients with obstructive uropathy and renal tubular acidosis [ 1617 ]. 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.


Prevalence, pathogenesis, and functional significance of aldosterone deficiency in hyperkalemic patients with chronic renal insufficiency. Choice of method depends on local circumstances and hemodynamics of the patients, as critical ill patients will rarely tolerate HD sessions [ 38 ]. Support Center Support Center. Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas in a gram infant with hyperkalemia.

Oxford University Press, p Author information Article notes Copyright and License information Disclaimer. Renal tubular handling of potassium in children with insulin-dependent diabetes mellitus.

N Engl J Med. Open in a separate window.

Salbutamol versus cation-exchange resin kayexalate for the treatment of nonoliguric hyperkalemia in preterm infants. 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.

Pathogenesis, diagnosis and management of hyperkalemia

Hyperkalemia is rarely associated with symptoms, occasionally patients complain of palpitations, nausea, muscle pain, or paresthesia. Ca-Gluconate does not have a potassium-lowering effect.

Retrospective review of the frequency of ECG changes in hyperkalemia. Hyperkalemia, congestive heart failure, and aldosterone receptor antagonism.

It modulates excretion of not only potassium but also calcium and magnesium. Hypoaldosteronism may either be primary e. Close electrolyte and blood glucose monitoring is needed, hypoglycemia being the main side-effect.