The effects of hyperkalemia on the body

Written by Wei Shi Liang

Intensive Care Unit

Updated on September 02, 2024

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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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Written by Zhao Xin Lan

Endocrinology

1min 27sec

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Principles of treatment for hyperkalemia

First, to counteract the cardiac inhibitory effects of potassium, calcium salts can be injected, and sodium bicarbonate can be used to alkalinize the blood. Then, an infusion of hypertonic glucose and insulin can be administered to promote the internal movement of potassium ions. Secondly, to promote the excretion of potassium, diuretics can be used. The second method involves the use of cation exchange resins and sorbitol. The third method employs dialysis therapy, which can include both hemodialysis and peritoneal dialysis. The fourth method is to reduce the sources of potassium, stop a high potassium diet or the use of potassium-containing drugs. In cases of severe hyperkalemia, where there is a life-threatening emergency, urgent measures should be taken, primarily the intravenous administration of calcium ion antagonists to counteract the cardiac toxicity of potassium. In cases of severe arrhythmias or even cardiac arrest, emergency installation of a pacemaker or defibrillation can be carried out, and respiratory muscle paralysis may require ventilatory support. (Medication use should be under the guidance of a doctor)

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Written by Wang Li Bing

Intensive Care Medicine Department

49sec

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How is hyperkalemia treated?

Hyperkalemia must be handled immediately after it occurs, otherwise it can cause malignant arrhythmias and even endanger life. The first step is to stop potassium supplements, such as potassium chloride sustained-release tablets; the second step is to stop potassium-sparing diuretics, such as spironolactone and other drugs. We can administer calcium intravenously to antagonize the toxic effects of high potassium on the heart. Additionally, we can use high glucose with insulin and intravenously drip sodium bicarbonate, which can promote the movement of potassium into cells. We can also use diuretics to excrete potassium through urine. If the treatment effect is poor after medication, we can use bedside hemodialysis to reduce blood potassium.

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Written by Wei Shi Liang

Intensive Care Unit

1min 18sec

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Common symptoms of hypokalemia and hyperkalemia

The common symptoms of hyperkalemia and hypokalemia, mainly seen in severe cases of high or low potassium, manifest as neurological and muscular symptoms as well as circulatory system symptoms, which are fairly similar in both conditions. If the blood potassium is particularly low, less than 2.0 mmol per liter, it can lead to reduced or absent reflexes. In severe cases, this may progress to paralysis of the respiratory muscles, causing respiratory pump failure. For hyperkalemia, particularly severe cases may also present with swallowing difficulties and respiratory distress. These central nervous system issues can lead to confusion and fainting. Another similar issue is the impact on the circulatory system; severe hypokalemia can cause ventricular tachycardia and even ventricular fibrillation, leading to death. In hyperkalemia, the impact on the cardiovascular system primarily causes malignant tachycardia and can also result in ventricular fibrillation. The main cause of sudden death in hyperkalemia is ventricular fibrillation and cardiac arrest, demonstrating that severe hyperkalemia and hypokalemia similarly cause significant arrhythmic conditions in the heart.

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Written by Chen Li Ping

Endocrinology

53sec

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Why should calcium be supplemented for hyperkalemia?

When high potassium levels trigger ventricular automaticity, it is recommended to administer calcium to counteract its cardiotoxicity. This is because during hyperkalemia, the excitability of the myocardium significantly increases. Calcium ions do not affect the distribution of potassium inside and outside the cells, but they can stabilize the excitability of the heart. Therefore, even if a patient's blood calcium level is normal, calcium should be injected immediately when there is severe arrhythmia. Calcium ions only temporarily counteract the toxicity of potassium to the heart and do not reduce the concentration of potassium in the blood. Thus, they can only serve as a short-term emergency medication. (Medication should be used under the guidance of a doctor.)

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Written by Wei Shi Liang

Intensive Care Unit

56sec

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What are the causes of hyperkalemia?

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.