From the Guidelines
Hyperkalemia is primarily caused by kidney dysfunction, which impairs potassium excretion, and can also be caused by medications that affect potassium balance, such as ACE inhibitors, ARBs, potassium-sparing diuretics, and NSAIDs, as well as adrenal disorders and excessive potassium intake. The causes of hyperkalemia can be categorized into several key areas, including:
- Kidney dysfunction, such as acute or chronic kidney disease, which impairs the body's ability to excrete potassium 1
- Medications that affect potassium balance, including:
- ACE inhibitors and ARBs, which can increase potassium levels by reducing aldosterone production 1
- Potassium-sparing diuretics, such as spironolactone, which can increase potassium levels by reducing potassium excretion 1
- NSAIDs, which can increase potassium levels by reducing potassium excretion 1
- Adrenal disorders, such as Addison's disease, which can reduce aldosterone production and lead to hyperkalemia 1
- Excessive potassium intake, including:
- Potassium supplements 1
- Salt substitutes, such as those containing potassium chloride 1
- Certain foods, such as bananas, melons, and orange juice, which are high in potassium 1
- Other contributors, including:
- Massive cell destruction, such as in tumor lysis syndrome, rhabdomyolysis, or severe burns, which can release intracellular potassium into the bloodstream 1
- Acidosis, which can drive potassium out of cells and into the bloodstream 1
- Certain medications, such as beta-blockers and digoxin, which can interfere with cellular potassium uptake 1
- Pseudohyperkalemia, a falsely elevated potassium reading, which can occur with hemolysis during blood collection, extreme thrombocytosis, or leukocytosis 1
It is essential to identify and address the underlying cause of hyperkalemia to prevent cardiac complications and other adverse outcomes. Management typically involves restricting dietary potassium, administering calcium gluconate, insulin with glucose, beta-agonists, or dialysis to rapidly lower potassium levels, and addressing the underlying cause of the hyperkalemia 1.
From the Research
Causes of Hyperkalemia
The causes of hyperkalemia can be attributed to various factors, including:
- Medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) that can increase serum potassium levels 2, 3, 4, 5
- Renal insufficiency or chronic kidney disease, which can lead to impaired potassium excretion 2, 3, 6, 4, 5
- Congestive heart failure, which can increase the risk of hyperkalemia 2, 6
- Excessive potassium intake from diet, supplements, or drugs 4
- Certain medical conditions, such as diabetes mellitus and ischemic heart disease 5
Risk Factors for Hyperkalemia
Several risk factors can increase the likelihood of developing hyperkalemia, including:
- Age over 70 years 2
- Serum urea nitrogen level higher than 6.4 mmol/L (18 mg/dL) or creatinine level higher than 136 mumol/L (1.5 mg/dL) 2
- Use of long-acting ACE inhibitors 2
- Concurrent use of loop or thiazide diuretic agents, which can reduce the risk of hyperkalemia 2
- Chronic kidney disease stage 4 or 5, which can increase the prevalence of hyperkalemia 5
Clinical Context and Hyperkalemia
The clinical context in which hyperkalemia develops is important in determining patient outcome, and factors such as physiologic adaptation, structural cardiac disease, medication use, and degree of concurrent illness can influence the risk of toxicity 6