Differential Diagnosis for Hyperkalemia
The differential diagnosis for hyperkalemia can be organized into the following categories:
- Single Most Likely Diagnosis
- Chronic Kidney Disease (CKD): This is often the most common cause of hyperkalemia due to the kidney's reduced ability to excrete potassium.
- Other Likely Diagnoses
- Medication-induced (e.g., ACE inhibitors, ARBs, beta-blockers, potassium-sparing diuretics): Various medications can lead to hyperkalemia by either reducing potassium excretion or increasing potassium levels.
- Cell lysis (e.g., tumor lysis syndrome, rhabdomyolysis): Conditions that cause cell breakdown can release large amounts of potassium into the bloodstream.
- Adrenal insufficiency: Reduced aldosterone production can lead to decreased potassium excretion.
- Dietary excess: Consuming high amounts of potassium-rich foods or supplements can contribute to hyperkalemia.
- Do Not Miss Diagnoses
- Acute kidney injury (AKI): Sudden loss of kidney function can rapidly lead to life-threatening hyperkalemia.
- Hyperkalemic periodic paralysis: A rare genetic disorder that can cause life-threatening hyperkalemia episodes.
- Pseudohyperkalemia (e.g., due to hemolysis, thrombocytosis, or leukocytosis): Incorrectly measured high potassium levels due to laboratory errors or certain blood conditions.
- Rare Diagnoses
- Familial hyperkalemic periodic paralysis: A rare genetic disorder affecting potassium channels.
- Gordon's syndrome (familial hyperkalemic hypertension): A rare genetic disorder characterized by hyperkalemia, hypertension, and normal renal function.
- Liddle's syndrome: A rare genetic disorder affecting sodium and potassium transport in the kidneys.
- 17-alpha-hydroxylase deficiency: A rare genetic disorder affecting steroid hormone production, which can lead to hyperkalemia.