From the Guidelines
Hyperkalemia is primarily caused by kidney dysfunction, medications that affect potassium balance, and increased potassium intake, with the most significant risk factors being chronic kidney disease, diabetes, and heart failure, as well as the use of renin-angiotensin-aldosterone system inhibitors (RAASi) 1. The causes of hyperkalemia can be categorized into several key areas, including:
- Decreased potassium excretion, which can be caused by medications such as potassium-sparing diuretics, beta-blockers, NSAIDs, and RAASi, as well as conditions like chronic kidney disease and adrenal insufficiency 1
- Increased potassium intake or administration, which can occur through potassium supplements, certain foods like bananas and melons, and salt substitutes 1
- Shift of potassium from intracellular to extracellular space, which can be caused by conditions like metabolic acidosis, insulin deficiency, and massive cell destruction 1
- Pseudohyperkalemia, which can occur due to hemolysis during blood collection or prolonged tourniquet use 1 It is essential to identify the underlying cause of hyperkalemia to provide appropriate treatment and prevent complications, as hyperkalemia can lead to cardiac arrhythmias and even sudden cardiac arrest 1. The management of hyperkalemia depends on the severity of the condition, but may include medications like calcium gluconate, insulin, and sodium bicarbonate, as well as diuretics and dialysis in severe cases 1. Some of the key medications that can cause hyperkalemia include:
- Potassium-sparing diuretics like spironolactone and eplerenone
- ACE inhibitors like lisinopril
- ARBs like losartan
- NSAIDs
- Potassium supplements
- Certain foods like bananas and melons
- Salt substitutes like DASH 1 Overall, the management of hyperkalemia requires a comprehensive approach that takes into account the underlying cause of the condition, as well as the patient's overall health status and medical history 1.
From the Research
Causes of Hyperkalemia
- Decreased renal excretion 2, 3, 4, 5, 6
- Excess intake or potassium shifting from the intra- to the extracellular space in combination with reduced renal excretion or impairment of regulation 2
- Impaired renal excretion, transcellular shifts, or increased potassium intake 3
- Acute renal failure 4
- Drugs (potassium sparing diuretics, angiotensin converting enzyme inhibitors) 4, 5, 6
- Hyperglycaemia 4
- Rhabdomyolysis 4
- Adrenal insufficiency 4
- Intrinsic disease of the collecting duct, disturbances in mineralocorticoid activity, and/or decreased delivery of sodium to the distal nephron 5
- Chronic kidney disease (CKD) and heart failure (HF) 5, 6
- Diabetes mellitus 6