Causes of Hyperkalemia

Written by Wei Shi Liang
Intensive Care Unit
Updated on February 06, 2025
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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 Wei Shi Liang
Intensive Care Unit
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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.

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Written by Chen Li Ping
Endocrinology
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Can hyperkalemia be cured?

The main focus is on the cause of hyperkalemia. If hyperkalemia is due to consuming foods rich in potassium, administration of potassium-containing solutions, transfusion of stored blood, use of potassium-sparing diuretics like spironolactone, or prolonged venipuncture causing severe shaking of the blood sample during transport, addressing these causes can prevent the occurrence of hyperkalemia. If hyperkalemia is caused by certain diseases, such as renal failure or adrenal insufficiency, active treatment of the underlying disease is required. If the renal failure is acute, recovery of kidney function might prevent the recurrence of hyperkalemia. However, if there is chronic renal insufficiency, there tends to be a higher recurrence rate of hyperkalemia. Therefore, whether hyperkalemia can be cured largely depends on identifying the underlying cause.

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Written by Zhao Xin Lan
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How should hyperkalemia be managed?

First, it is necessary to assess the severity of the hyperkalemia, whether it is mild, moderate, or severe. For mild hyperkalemia, it can be managed by taking oral diuretics or intravenous infusion of glucose with insulin, which can normalize the potassium level. In cases of severe hyperkalemia, where blood potassium exceeds 7.5 mmol/L, there is a risk of causing cardiac arrest. Emergency measures to promote potassium excretion are required, such as hemodialysis or peritoneal dialysis. It is also necessary to counteract the myocardial depressive effects of potassium, which can be managed with the injection of calcium gluconate, along with the intravenous infusion of hypertonic glucose and insulin. (The use of medications should be conducted under the guidance of a doctor.)

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Written by Wei Shi Liang
Intensive Care Unit
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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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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.)