Why should calcium be supplemented for hyperkalemia?

Written by Chen Li Ping
Endocrinology
Updated on February 08, 2025
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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
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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 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 Chen Li Ping
Endocrinology
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Hyperkalemia

Typically, when serum potassium exceeds 5.5 mmol/L, it is referred to as hyperkalemia. However, an increase in serum potassium does not necessarily reflect an overall increase in body potassium; serum potassium can also rise when there is a deficiency of total body potassium. Therefore, in clinical practice, serum potassium is evaluated in conjunction with an electrocardiogram and medical history to determine if a patient has hyperkalemia. Hyperkalemia is an important emergency in internal medicine and can often lead to sudden cardiac arrest. It should be identified and prevented early.

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Written by Wei Shi Liang
Intensive Care Unit
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Common Causes of Hyperkalemia

Hyperkalemia is when the serum potassium concentration exceeds 5.5 millimoles per liter. Common causes include excessive potassium intake and large doses of potassium salts, which can lead to hyperkalemia, as well as the use of stored blood. Another cause is reduced potassium excretion; in patients with renal insufficiency, reduced urine output or anuria leads to decreased renal potassium excretion. If potassium supplementation is inappropriate at this time, or if potassium-sparing diuretics are used, severe hyperkalemia can occur. Another scenario is the leakage of intracellular potassium during respiratory and metabolic acidosis, where sodium ion exchange occurs in cells, hydrogen ions enter the cells, and potassium ions leak out to the extracellular space, which can lead to increased blood potassium. These are the common causes of 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.)