Common causes of hyperkalemia

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 09, 2024
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Hyperkalemia is caused by increased intake or decreased excretion, or by the transfer of potassium ions from inside the cells to the outside. Increased intake generally does not cause hyperkalemia in individuals with normal kidney function, unless potassium is supplemented intravenously in excessive amounts or too quickly. Moreover, decreased excretion is a major cause of hyperkalemia, typically seen in renal failure, deficiency of adrenocortical hormones, and primary renal tubular disorders in potassium secretion. Additionally, a large transfer of potassium ions from inside the cells to the outside can occur in conditions such as massive cell breakdown, acidosis, tissue hypoxia, periodic paralysis, and insulin deficiency.

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How to treat vomiting caused by hyperkalemia?

For patients with hyperkalemia, early symptoms include numbness in the limbs, weakness, muscle soreness, and paralysis. As the condition progresses, it can suppress myocardial function, reducing the tension of the myocardium and leading to slow heartbeats, and even cause arrhythmias and cardiac arrest. Increased release of acetylcholine can also cause nausea, vomiting, abdominal pain, and other symptoms. Patients with this condition generally also exhibit symptoms of hyperlipidemia and metabolic acidosis. For mild cases of hyperkalemia, temporary treatment may not be necessary, and symptomatic treatment such as stopping vomiting and drinking water may be sufficient. However, in acute cases, it is recommended that the patient immediately undergo dialysis or receive diuretic injections to rapidly eliminate potassium ions from the body, and to stop consuming foods and medications that contain potassium.

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Written by Luo Han Ying
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What should not be eaten with hyperkalemia?

Potassium is an important element in human blood. Typically, the electrolytes we measure in blood tests include sodium, potassium, chloride, and calcium. Both low and high levels of potassium can have adverse effects on the body, especially hyperkalemia, which can cause sudden cardiac arrest and is considered dangerous in clinical settings. Patients with normal kidney function are less likely to develop hyperkalemia, which is more commonly seen in those who may have consumed Chinese herbal medicines containing high amounts of potassium for a long time. In patients with renal insufficiency, due to impaired kidney excretory function, hyperkalemia occurs more easily. Patients with hyperkalemia should generally avoid ACE inhibitors and ARB medications. For example, drugs like ACE inhibitors and spironolactone can further exacerbate hyperkalemia, so these types of medications are definitely not advisable. (The use of medications should be under the guidance of a professional doctor.)

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Written by Wei Shi Liang
Intensive Care Unit
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Clinical manifestations of hyperkalemia

The clinical manifestations of hyperkalemia mainly affect the cardiovascular system, often presenting with slowed heart rate and various arrhythmias. When the blood potassium level is between 6.6 and 8.0 mmol/L, a tent-shaped T-wave can be observed. Rapid increases in blood potassium can lead to ventricular tachycardia, and even ventricular fibrillation. A gradual increase in blood potassium can cause conduction blocks, and in severe cases, cardiac arrest. Sudden death in severe hyperkalemia is mainly due to ventricular fibrillation and cardiac arrest. The second aspect is symptoms related to the neuromuscular system. As the concentration of potassium ions in the extracellular fluid increases, the resting membrane potential drops, leading to muscle weakness and even paralysis, typically more pronounced in the lower limbs and extending upward along the trunk. In severe cases, some patients may experience difficulty in swallowing and breathing difficulties. Symptoms involving the central nervous system mainly include restlessness, confusion, and fainting.

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Written by Wei Shi Liang
Intensive Care Unit
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Causes of Hyperkalemia

Common causes of hyperkalemia in clinical settings include: First, it is related to excessive intake. Generally, a high-potassium diet under normal kidney function does not cause hyperkalemia. It only occurs when there is excessive or rapid intravenous potassium supplementation, or when kidney function is impaired. Second, hyperkalemia caused by reduced excretion. Common reasons include renal failure, lack of adrenocortical hormones, and primary renal tubular potassium secretion disorders, all of which can cause hyperkalemia. Third, a large transfer of potassium ions from inside the cells to the outside can also cause hyperkalemia.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Treatment methods for hyperkalemia

In clinical practice, a blood potassium level greater than 5.5 millimoles per liter is referred to as hyperkalemia. Once hyperkalemia occurs, it must be actively managed: the first step is to stop using medications that increase blood potassium, such as sustained-release potassium chloride, potassium-sparing diuretics like spironolactone, and ACE inhibitors; the second step is to use calcium supplements to counteract the toxic effects of high potassium on the heart; the third step is to use hypertonic glucose with insulin and sodium bicarbonate to correct acidosis and promote the movement of potassium into the cells; the fourth step is to use the diuretic furosemide to help reduce blood potassium. If drug treatment is ineffective, bedside hemodialysis may be employed. (Use of the above medications should be under the guidance of a doctor.)