From the Guidelines
Hyperkalemia symptoms include flaccid paralysis, paresthesia, depressed deep tendon reflexes, shortness of breath, and cardiac arrhythmias, with early electrocardiographic signs such as peaked T waves, followed by flattened or absent T waves, prolonged PR interval, widened QRS complex, and deepened S waves 1. The clinical presentation of hyperkalemia can vary from mild to severe, often correlating with the level of potassium elevation.
- Early symptoms may be non-specific and include muscle weakness, fatigue, and numbness or tingling sensations.
- As potassium levels rise, patients may experience more pronounced muscle weakness, paralysis, and irregular heartbeats.
- Severe hyperkalemia can cause dangerous cardiac effects, including heart palpitations, slow heart rate, and potentially life-threatening arrhythmias. The electrocardiographic signs of hyperkalemia are critical for diagnosis, with the earliest sign being peaked T waves on the ECG, followed by progressive changes such as flattened or absent P waves, prolonged PR interval, widened QRS complex, and deepened S waves 1.
- If left untreated, hyperkalemia can lead to a sine-wave pattern, idioventricular rhythms, and asystolic cardiac arrest.
- Prompt recognition of these symptoms is essential, as severe hyperkalemia can lead to cardiac arrest if left untreated, particularly in patients with kidney disease, those taking certain medications, and individuals with Addison's disease. The most recent guidelines emphasize the importance of early recognition and treatment of hyperkalemia to prevent cardiac complications, highlighting the need for vigilant monitoring of potassium levels and electrocardiographic changes in high-risk patients 1.
From the Research
Symptoms of Hyperkalemia
The symptoms of hyperkalemia are often nonspecific, but can include:
- Muscle weakness
- Paralysis
- Cardiac dysrhythmias, which may result in cardiac arrest and death 2, 3, 4
- Electrocardiography abnormalities, such as cardiac conduction disturbances 3, 4, 5
Diagnosis and Clinical Considerations
Hyperkalemia can be detected via serum clinical laboratory measurement 2 and is associated with fatal dysrhythmias and muscular dysfunction 3. A history and physical examination can be beneficial in the diagnosis of the condition, along with laboratory potassium levels and characteristic electrocardiogram findings 3. Certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others, can lead to hyperkalemia 3, 6, 5.
Treatment and Management
Treatment of hyperkalemia includes measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion 2. This can be achieved through the use of:
- Calcium gluconate or calcium chloride to stabilize cardiac membranes 2, 4
- Insulin, glucose, and beta-2 agonists to shift potassium into cells 2, 3, 4
- Diuretics, such as loop and thiazide diuretics, to promote potassium excretion 2, 4
- Dialysis, which is the most efficient means of removing excess potassium 2, 4, 6
- Newer potassium binders, such as patiromer and sodium zirconium cyclosilicate, which may be used in chronic or acute hyperkalemia 2, 3, 4, 6