What are the causes of hyperkalemia?

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 05, 2024
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Hyperkalemia, with blood potassium levels greater than 5.5 mmol/L, commonly occurs due to decreased potassium excretion or abnormal potassium transport within cells, as well as other reasons such as excessive intake. Decreased potassium excretion can commonly be due to renal failure, the use of potassium-sparing diuretics, renal tubular acidosis, and reduced secretion of corticosteroid aldosterone. Abnormal potassium transport includes conditions such as acidosis, rhabdomyolysis, extensive burns, severe trauma, intestinal necrosis, and peritoneal bleeding, among other diseases. Excessive potassium intake can be due to sample hemolysis or an elevation in white blood cells, both of which can lead to hyperkalemia. Therefore, it is crucial to be vigilant in clinical settings and address the condition promptly and appropriately.

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Written by Wei Shi Liang
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The effects of hyperkalemia on the body

Hyperkalemia affects the body mainly in three aspects. Firstly, hyperkalemia impacts muscle tissues, clinically manifesting as symptoms such as muscle tremors. Secondly, the effect of hyperkalemia on the heart primarily manifests as decreased excitability, conductivity, and automaticity of the myocardium. It affects electrocardiograms, characterized by a depressed P wave, widened QS wave, reduced R wave, and elevated T wave. Thirdly, hyperkalemia affects acid-base balance; during hyperkalemia, potassium efflux from cells can lead to metabolic acidosis, resulting in alkaline urine.

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Treatment of Hyperkalemia with Drugs

Hyperkalemia primarily affects the conduction of the heart and muscle nerves, with typical clinical manifestations including severe bradycardia, atrioventricular block, and even sinus arrest. Once hyperkalemia occurs clinically, immediate treatment should be administered. The first approach to treatment is promoting the excretion of potassium, using furosemide or other diuretics to increase renal potassium excretion, and taking a small dose of sodium polystyrene sulfonate orally to eliminate potassium. For life-threatening severe hyperkalemia, if serum potassium is greater than 6.5 mmol/L, hemodialysis treatment is necessary. The second aspect involves shifting potassium into cells, using calcium to alter cell excitability, which can protect the heart from the damage to the conduction system caused by hyperkalemia. Additionally, using glucose with insulin and administering sodium bicarbonate can be effective. It is important to note that all the above medications should be used under the guidance of a doctor.

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The difference between hyperkalemia and hypokalemia

Potassium ions are one of the essential electrolytes necessary for human life. Their physiological functions include maintaining cell metabolism, regulating osmotic pressure and acid-base balance, and preserving cell emergency functions, among others. The normal concentration of serum potassium is between 3.5 and 5.5 millimoles per liter. If it falls below 3.5 millimoles per liter, it is categorized as hypokalemia. If it exceeds 5.5 millimoles per liter, it is categorized as hyperkalemia. Common causes of hypokalemia include insufficient potassium intake, excessive potassium excretion, and the shifting of potassium from outside to inside the cells. The main causes of hyperkalemia include increased intake or reduced excretion of potassium, as well as substantial movement of potassium from inside the cells to the outside. Whenever hyperkalemia or hypokalemia occurs, it should be actively managed.

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Why does hyperkalemia cause acidosis?

The concentration of potassium ions in serum is 3.5 to 5.5 millimoles per liter, and concentrations above 5.5 millimoles per liter are considered hyperkalemia. In the state of hyperkalemia, potassium ions in the extracellular fluid move into the intracellular fluid, while hydrogen ions in the intracellular fluid move to the extracellular fluid. At this time, through a compensatory mechanism, there is an increase in hydrogen ions in the extracellular fluid, significantly higher than normal levels, resulting in acidosis. Therefore, hyperkalemia often accompanies metabolic acidosis, which in turn affects the renal tubular epithelial cells, causing an abnormal alkaline urine. This is the main reason why hyperkalemia leads to acidosis.

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What kind of urine occurs with hyperkalemia?

Primary hyperkalemia often coincides with metabolic acidosis, and in hyperkalemia-induced metabolic acidosis, paradoxical alkaline urine can occur. Once hyperkalemia occurs, it primarily affects the conduction of the heart and neuromuscular system. Typical clinical manifestations include severe bradycardia, atrioventricular conduction block, and even sinus arrest. In mild hyperkalemia, the electrocardiogram shows peaked T-waves; as potassium levels continue to rise, the PR interval prolongs, T-waves disappear, QRS complex widens, and ultimately, cardiac arrest occurs. Immediate treatment should be administered upon diagnosis to promote the excretion of potassium, maximizing the renal excretion capacity with diuretics. If drug-induced potassium excretion does not normalize levels and serum potassium exceeds 6.5 mmol/L, hemodialysis may be necessary. Additionally, some drugs can be used to shift potassium into the cells and protect cardiac function. (The use of any medication should be under the guidance of a doctor.)