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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Excessive intake In patients with unimpaired renal function and intact other regulatory mechanisms, large amounts of potassium are needed to achieve hyperkalemia [ 11 ].

Low nemj potassium concentrations of 3. Therapeutic strategies should be individualized, taking into account the degree and the cause of hyperkalemia. PHA type I caused by autosomal dominant mutations in the human mineralocorticoid receptor MR gene is limited to the kidneys.

Effect of vasopressin analogue dDAVP on potassium transport in medullary collecting duct.

Anja Lehnhardt and Markus J. If elevated serum potassium is found in an asymptomatic patient with no apparent cause, factitious hyperkalemia should be considered. Palmer LG, Frindt G.

In patients with unimpaired renal hyeprkalemia and intact other regulatory mechanisms, large amounts of potassium are needed to achieve hyperkalemia [ 11 ]. Pseudohyperkalemia If elevated serum potassium is found in an asymptomatic patient with no apparent cause, hyperkaelmia hyperkalemia should be considered. Mineral acidosis is more likely to cause a shift of potassium from intracellular space into extracellular space than organic acidosis.


Oxford University Press, p Handling of potassium in the nephron depends on passive and active mechanisms. In summary and conclusion, the effective and rapid diagnosis and management of acute and chronic hyperkalemia in children, especially if renal function is impaired, is clinically relevant and can be life-saving.

Pathogenesis, diagnosis and management of hyperkalemia

Diagnostic algorithm in hyperkalemia; adapted from Clinical Paediatric Nephrology. J Am Coll Nutr.

Excretion mainly occurs in the cortical collecting duct [ 2 ]. Induction of hyporeninemic hypoaldosteronism through inhibiting renal prostaglandin synthesis. It can cause tachycardia. Prevalence, pathogenesis, and functional significance of aldosterone deficiency in hyperkalemic patients with chronic renal insufficiency.

Salbutamol versus cation-exchange resin kayexalate for the treatment of nonoliguric hyperkalemia in preterm infants. Hyperkalemia is rarely associated with symptoms, occasionally patients complain of palpitations, nausea, muscle pain, or paresthesia. Examination and investigations should be systematic and always include assessment of cardiac function, kidneys, and urinary tract as well as hydration status and neurological evaluation.

Management should not only rely on ECG changes but be hyyperkalemia by the clinical scenario and serial potassium measurements [ 2931 ].

Acid-base balance can affect the balance between cellular and extracellular potassium concentration. Acute increase in osmolality secondary to hyperglycemia or mannitol infusion causes potassium to exit from cells [ 24 ]. Sodium bicarbonate, preferably given to patients who are acidotic. Kemper MJ Potassium and magnesium physiology. Reduction in adrenal aldosterone biosynthesis through interrupting renin-aldosterone axis. In the presence of renal failure, the proportion of potassium excreted through the gut can increase, but is subject to high inter-individual variability [ 1 ].


Pathogenesis, diagnosis and management of hyperkalemia

Pathogenesis of hyperkalemia Hyperkalemia may result from an increase in total body potassium hyperaklemia to imbalance of intake vs. An effect can often be seen immediately but response remains unpredictable. Margassery S, Bastani B. Clin J Am Soc Nephrol.

hypeerkalemia Ion-exchange resins containing calcium or sodium aim to keep enteral potassium from being resorbed. Combined treatment with spironolactone and ACE inhibitors, especially in patients with renal impairment or heart failure, has to be monitored very carefully.

Potassium homeostasis and Renin-Angiotensin-aldosterone system inhibitors. Mechanisms in hyperkalemic renal tubular acidosis. Choice of method depends on local circumstances and hemodynamics of the patients, as critical ill patients will rarely tolerate HD sessions [ 38 ]. Which drug does not cause hyperkalemia? Transient type 1 pseudo-hypoaldosteronism: