Hyperkalaemia Flashcards
function of potassium
Potassium (K+) is involved in maintaining the resting cell membrane potential
problems caused by small shifts in potassium concentration
problems with muscle and nerve conduction, leading to potentially life-threatening disorders of the cardiac and neuromuscular systems
normal plasma concentration of potassium
3.5-5.5 mEq/L
definition of hyperkalemia
Hyperkalemia is defined as a potassium level of >5.5 mEq/L
mild hyperkalemia
5.5-5.9 mmol/l
moderate hyperkalemia
6.0-6.4 mmol/l
severe hyperkaelemia
> 6.5 mmol/l
pathophysiology of hyperkaelemia
About 98% of total body potassium (K+) is Intracellular and off this, 75% is contained in skeletal muscle cells.
The remaining 2% extracellular component is maintained within a tight range of 3.5 to 5.5 mEq/L (1 mmol equals 1 mEq K+) by the body.
The main mechanism by which this trans-cellular ratio is maintained is through the sodium-potassium (Na-K) adenosine triphosphatase (ATPase) pump. It uses ATP to drive K+ into cells in exchange for sodium (Na).
The resulting K+ gradient creates a resting membrane potential that determines cardiac and neuromuscular cell excitability and signal conduction
Because the extracellular K+ level is proportionally so much less than the intracellular level, even a small change in the extracellular level significantly alters the resting membrane potential.
This leads to decrease muscle contractile strength, evident in the typical clinical presentation
categories’ of the causes of hyperkalemia
- Imbalance between intake and excretion of K leading to total body excess
- trans-cellular shifts/ excessive tissue release
- measurement error.
number one cause of hyperkalaemia
spurious elevation
other common causes of hyperkalemia
Chronic renal failure (the true number one cause of hyperkalaemia)
Acidosis (potassium moves out of the cell as the pH falls)
Drug induced (including nonsteroidal anti-inflammatory drugs, potassium-sparing diuretics, digoxin, angiotensin-converting enzyme inhibitors, and administration of intravenous potassium chloride)
Cell death (when potassium comes out of injured muscle or red cells); including burns, crush injuries, rhabdomyolysis, tumour lysis syndrome, and intravascular haemolysis.
Much less common causes of hyperkalaemia include adrenal insufficiency, hyperkalaemic periodic paralysis, and hematologic malignancies.
disorders causing hyperkalaemia
- failure of excretion
- transcellular shifts (Na-K ATPase pump)
- measurement error (pseudohyperkalemia)
- large, rapid potassium load
failure of excretion
-Decreased glomerular filtration rate
^^Renal Injury
-Heart failure
-Obstructive uropathy
-Low aldosterone level
^^Adrenal insufficiency (Addison disease)
^^Low renin level
-Type 4 renal tubular acidosis
-Medications that inhibit Na-K ATPase in the distal nephron
transcellular shifts (Na- K ATPase pump)
-Haemolysis
^^Rhabdomyolysis
^^Tumour lysis syndrome
^^Haematoma reabsorption
-Medications that inhibit Na-K ATPase pump
-Insulin deficiency
^^Diabetes mellitus
^^Prolonged fasting
-Hypertonicity
^^Hyperglycaemia
^^Hypernatremia
-Acidosis
-Hyperkalaemia periodic paralysis (mutation of skeletal muscle Na-K pump)
measurement error (pseudohyperkalemia)
-Haemolysis during blood draw
^^Prolonged tourniquet use
^^Small needle calibre
^^Excessive fist clenching
^^Excessive plunger force to pull blood into a syringe
-Haemolysis before laboratory analysis
^^Delay between blood draw and analysis
^^Aggressive sample shaking
-Hyperviscosity
^^Extreme leukocytosis
^^Extreme thrombocytosis
^^Polycythemia vera