Can hyperkalemia result in cardiogenic shock?

From the Guidelines

Yes, severe hyperkalemia can potentially lead to cardiogenic shock. Hyperkalemia (high blood potassium levels) can cause dangerous heart rhythm disturbances, including ventricular fibrillation and asystole, as noted in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. These arrhythmias can severely impair the heart's ability to pump blood effectively, resulting in cardiogenic shock. Severe hyperkalemia is typically defined as a serum potassium level above 6.5 mEq/L, at which levels cardiac effects become more pronounced and dangerous, as described in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. To prevent progression to cardiogenic shock, urgent treatment of severe hyperkalemia is crucial:

• Calcium gluconate 10% solution: 10 mL IV over 2-3 minutes to stabilize cardiac membranes, as recommended in the 2021 Mayo Clinic Proceedings article on clinical management of hyperkalemia 1
• Insulin with glucose: 10 units regular insulin IV with 25g dextrose to shift potassium into cells
• Sodium bicarbonate: 50 mEq IV if metabolic acidosis is present
• Beta-2 agonists: Albuterol 10-20 mg nebulized to shift potassium into cells
• Potassium binders: Sodium polystyrene sulfonate 15-30 g orally or rectally
• Dialysis may be necessary in severe cases or renal failure Continuous cardiac monitoring is essential during treatment, and the underlying cause of hyperkalemia should be identified and addressed to prevent recurrence, as emphasized in the 2018 European Heart Journal article on expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors 1.

From the FDA Drug Label

CLINICAL STUDIES Medical literature also refers to the administration of calcium chloride in the treatment of magnesium intoxication due to overdosage of magnesium sulfate, and to combat the deleterious effects of hyperkalemia as measured by electrocardiogram (ECG), pending correction of the increased potassium level in the extracellular fluid.

The FDA drug label does not answer the question.

From the Research

Hyperkalemia and Cardiogenic Shock

• Hyperkalemia can lead to severe cardiac arrhythmias and impair cardiovascular function, potentially resulting in cardiogenic shock 2.
• Severe hyperkalemia can cause abnormalities in cardiac depolarization and repolarization, contractility, and may result in sudden cardiac death if left untreated 3.
• Hyperkalemia is common in patients with acute myocardial infarction and is associated with a steep increase in mortality risk, even at mild levels of hyperkalemia 4.

Electrocardiographic Manifestations

• Electrocardiographic manifestations of severe hyperkalemia include peaking of the T waves, junctional rhythm, and QRS prolongation 5, 6.
• These manifestations can help identify patients with hyperkalemia who require prompt intervention 6.

Clinical Presentation and Outcomes

• Patients with severe hyperkalemia may present with hypotension, altered mentation, and require hemodynamic support, including temporary cardiac pacing 5.
• Hospital mortality rates for patients with severe hyperkalemia can be as high as 10% 5.
• Factors associated with receipt of hemodynamic-targeted treatment include a lack of dialysis dependence, junctional rhythm, and concomitant presentation with hypothermia, acidemia, or sepsis 5.