What are the symptoms of hyperkalemia?

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 02, 2024
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The effects of hyperkalemia on the body mainly include the following aspects:

First, the impact on muscle tissue: mild hyperkalemia can cause slight tremors in muscles. If the potassium levels continue to rise, this can lead to decreased neuromuscular excitability, resulting in limbs becoming weak and flaccid, and even leading to delayed paralysis.

Second, the impact on the cardiac system: it can cause a decrease in myocardial excitability, conductibility, and automaticity. The electrocardiogram shows a depressed P wave, widened QRS complex, shortened QT interval, and peaked T waves.

Third, hyperkalemia affects acid-base balance and can lead to metabolic acidosis during hyperkalemia.

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Written by Wang Li Bing
Intensive Care Medicine Department
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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 Wang Li Bing
Intensive Care Medicine Department
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Why is calcium used for hyperkalemia?

Hyperkalemia can increase the excitability of myocardial cells, leading to various malignant arrhythmias and even sudden death. Immediate treatment is necessary after hyperkalemia occurs. Clinically, it can be treated by hemodialysis or conservatively with medication. Why use calcium preparations for hyperkalemia? Because after using calcium preparations, the excitability of myocardial cells can be stabilized, effectively maintaining stable heart rates in patients and preventing sudden death due to malignant arrhythmias.

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Written by Wei Shi Liang
Intensive Care Unit
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The effect of hyperkalemia on the myocardium

The primary mechanism by which hyperkalemia causes arrhythmias is due to dysfunction of myocardial conduction, which is also related to various other factors such as other myocardial lesions, failure, and ionic states. The main impact on the myocardium is on its excitability; myocardial excitability can decrease or even disappear, and its conductivity is also affected, causing a reduction in conductivity. The effect on myocardial automaticity is a decrease in automaticity. Electrocardiographically, there are manifestations such as a low P wave, prolonged PR interval, and widened QRS complex without disappearance; these are some of the presentations of hyperkalemia.

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Written by Wei Shi Liang
Intensive Care Unit
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Is hyperkalemia acidosis?

Hyperkalemia is not acidosis, but during acidosis, the hydrogen ions of the gastric fluid within cells enter the cells, causing the potassium ions inside the cells to move to the extracellular fluid, resulting in hyperkalemia. Clinically, it is commonly seen in organic acidosis, lactic acidosis, diabetic ketoacidosis, and acute renal failure causing acidosis. Once hyperkalemia occurs and is diagnosed, immediate treatment should be administered. First, the primary disease should be treated; next, serum potassium should be reduced. In particularly severe cases, bedside hemofiltration can be administered, and the cardiotoxic effects of hyperkalemia should be mitigated.

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Endocrinology
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Clinical manifestations of hyperkalemia

The clinical manifestations of hyperkalemia are not specific. Early symptoms often include numbness in the limbs, sensory abnormalities, extreme fatigue, and muscle pain. In severe cases, there can be difficulties in swallowing, speaking, and breathing, paralysis of the limbs, and tendon reflexes may disappear. The central nervous system may show signs of restlessness, fainting, and confusion. Some may experience a slow heart rate, ventricular fibrillation, and in the most severe cases, it can lead to cardiac arrest. Other symptoms may include nausea, vomiting, diarrhea, and other gastrointestinal symptoms.