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Hyperkalemia Causes

Aka: Hyperkalemia Causes, Pseudohyperkalemia, Hyperkalemia due to Decreased Renal Excretion, Hyperkalemia due to Redistribution, Hyperkalemia due to Excessive Potassium Load
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  1. See Also
    1. Hyperkalemia
    2. Medication Causes of Elevated Serum Potassium
  2. Causes: Decreased renal excretion
    1. Hypoaldosteronism
      1. Hyporeninemic hypoaldosteronism
        1. Intrinsic renal disease (provoked by dehydration)
          1. Type IV Renal Tubular Acidosis
          2. Diabetes Mellitus (esp. Diabetic Nephropathy)
          3. Interstitial Nephritis
        2. Prostaglandin synthetase inhibitors
      2. Primary Hypoaldosteronism
      3. Medication
        1. Heparin
        2. Cyclosporine
        3. ACE Inhibitor
      4. Adrenal Insufficiency (volume low, decreased GFR)
    2. Renal Insufficiency or Renal Failure
    3. Renal Tubular Acidosis (Type 4)
    4. Congestive Heart Failure
      1. Decreased distal nephron sodium delivery
    5. Potassium sparing Diuretics
    6. Heparin
    7. NSAIDS
    8. Tubular unresponsiveness to aldosterone
      1. Systemic Lupus Erythematosus
      2. Multiple Myeloma
      3. Sickle Cell Anemia
  3. Causes: Redistribution (ICF to ECF)
    1. Acidosis (more likely with mineral acids NH4, HCl)
    2. Hyperkalemic periodic paralysis
    3. Insulin deficiency (Diabetes Mellitus)
    4. Rapid ECF rise
      1. Hypertonic Glucose or mannitol infused
    5. Dialysis
    6. Coronary bypass
    7. Medications
      1. Succinylcholine (if concurrent tissue damage)
      2. Beta Blockers
      3. Digitalis intoxication (Digoxin Toxicity)
      4. Arginine
    8. Tissue necrosis or Burn Injury
  4. Causes: Potassium load
    1. Oral or IV Potassium Supplementation
    2. Salt substitute
    3. Blood Transfusion
    4. High dose Penicillin (1.7 meq K+ per 1 Million Units)
    5. Endogenous
      1. Tumor lysis
      2. Burn Injury
      3. Crush injury
    6. Massive Hemolysis
    7. Surgery
    8. Gastrointestinal Bleeding
  5. Causes: Pseudohyperkalemia (Actual Serum Potassium less than lab)
    1. Blood sample clotted
    2. Delayed analysis or other lab error
    3. Excessive tourniquet or fist clenched repeatedly
    4. Hemolysis via small needle or traumatic venipuncture
    5. Severe Thrombocytosis
    6. Severe Leukocytosis
  6. References
    1. Gibbs in Marx (2002) Rosen's Emerg Med, p. 1730-1
    2. Klahr (2001) in Noble (2001) Primary Care p. 1359-62

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