From the Guidelines
Hyperkalemia in young adults is most commonly caused by medications that decrease potassium excretion, such as renin-angiotensin-aldosterone system inhibitors (RAASi), potassium-sparing diuretics, and NSAIDs, as well as increased potassium intake from supplements or certain foods. According to the most recent and highest quality study 1, medications that may cause hyperkalemia include:
- Potassium-sparing diuretics (e.g. spironolactone, triamterene, amiloride)
- Beta-blockers
- NSAIDs
- Sacubitril/valsartan
- Renin-angiotensin-aldosterone inhibitors (RAASi): ACE inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists (MRAs)
- Direct renin inhibitors (aliskiren)
- Mannitol
- Cyclosporine or tacrolimus
- Pentamidine
- Trimethoprim-sulfamethoxazole
- Heparin
- Digitalis
- Calcineurin inhibitors
- Penicillin G Additionally, increased potassium intake from sources such as:
- Potassium supplements
- Salt substitute (e.g. DASH)
- Fruits (bananas, melons, orange juice)
- Alfalfa
- Amino acids (aminocaproic acid, arginine, lysine)
- Dandelion
- Dried toad skin
- Hawthorne berry
- Horsetail
- Lily of the valley
- Milkweed
- Nettle
- Noni juice
- Siberian ginseng
- Stored blood products can also contribute to hyperkalemia. It is essential to note that the incidence of hyperkalemia with RAASi monotherapy is < 2% and increases to 5% with dual RAAS inhibition and to 5–10% when dual therapy is administered in patients with HF or chronic kidney disease 1. A more recent study 1 also highlights the risk of hyperkalemia in patients with chronic kidney disease, diabetes, and heart failure, and in individuals receiving RAASis. Therefore, it is crucial to monitor potassium levels closely in young adults taking these medications or with underlying risk factors.
From the Research
Causes of Hyperkalemia
- Hyperkalemia is a condition where serum potassium levels exceed 5.5 mmol/l, and it can be caused by various factors, including certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others 2, 3, 4.
- Reduced renal excretion, excessive intake, or leakage of potassium from the intracellular space can also lead to hyperkalemia 3, 4.
- Other conditions that can cause hyperkalemia include hypoaldosteronism, massive tissue breakdown, such as rhabdomyolysis, and the use of certain medications 3, 5, 4.
- Hyperkalemia can also be caused by transcellular shifts, which can occur due to various factors, including insulin deficiency, metabolic acidosis, and cell lysis 3, 6.
Risk Factors in Young Adults
- Young adults with chronic kidney disease, diabetes mellitus, or other medical conditions that affect kidney function are at a higher risk of developing hyperkalemia 2, 3, 4.
- The use of certain medications, such as renin-angiotensin-aldosterone system inhibitors, can also increase the risk of hyperkalemia in young adults 5.
- A diet high in potassium or the use of potassium supplements can also contribute to the development of hyperkalemia in young adults 6.