Medical Intelligence from The New England Journal of Medicine — VI. Hyperkalemia. Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds mmol/l. It can be caused by reduced renal excretion, excessive. n engl j med ;3 january 15, mmol per liter.1,2 Hyperkalemia is defined as erate hyperkalemia) and more than mmol per.

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Anja Lehnhardt and Markus J. In summary and conclusion, the effective and rapid diagnosis and management of acute and chronic hyperkalemia in children, especially if renal function is impaired, is clinically relevant and can be life-saving.

Hyperkalemia, Potassium, Renal failure, Salbutamol. Understanding the risk of hyperkalaemia in heart failure: The utility of the transtubular potassium gradient in the evaluation of hyperkalemia. J Am Soc Nephrol. Electrocardiography is unreliable in detecting potentially lethal hyperkalaemia in haemodialysis patients.

An inappropriately low TTKG in a hyperkalemic patient suggests hypoaldosteronism or a renal tubule defect [ 39 ]. Test is most useful in distinguishing patients who have mineralocorticoid deficiency versus resistance by observing a change in TTKG values after administration of mineralocorticoid: Diagnostic algorithm in hyperkalemia; adapted from Clinical Paediatric Nephrology. Increased shift of potassium from intra to extracellular space Acidosis: Choice of method depends on local circumstances and hemodynamics of the patients, as critical ill patients will rarely tolerate Mejm sessions [ 38 ].


In treatment of moderate to severe hyperkalemia, the combination of medications with different therapeutic approaches is usually hyperlalemia, and often methods of blood purification can be avoided. Life-threatening hyperkalemia and acidosis secondary to trimethoprim-sulfamethoxazole treatment. Aldosterone and potassium secretion by the cortical collecting duct.

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Pathogenesis, diagnosis and management of hyperkalemia

Weir MR, Rolfe M. Several co-transporters and ion channels are involved in the complex regulatory system of potassium reabsorption.

Handling of potassium in the nephron depends on passive and active mechanisms. Close electrolyte and blood glucose monitoring is needed, hypoglycemia being the main side-effect. Curr Opin Nephrol Hypertens.

Additionally, if unknown, the cause of hyperkalemia has to be determined to prevent future episodes. Pediatric Nephrology Berlin, Germany. Am J Emerg Med. Which of the following clinical conditions typically causes hyperkalemia answer true or false for a through e acute renal failure. In the presence of renal failure, the proportion of potassium excreted through the gut can increase, but is subject to high inter-individual variability [ 1 ].

Acute increase in osmolality secondary to hyperglycemia or mannitol infusion causes potassium to exit from cells [ 24 ]. Author information Article notes Copyright and License information Disclaimer.

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Pathogenesis, diagnosis and management of hyperkalemia

Examination and investigations should be systematic and always include assessment of cardiac function, kidneys, and urinary tract as well as hydration status and neurological evaluation. Regulation of renal ion transport by the calcium-sensing receptor: In hemodialysis patients with hyperkalemia it has only a moderate effect if given as prolonged infusion [ 35 ].

Knowledge of the physiological mechanisms of potassium handling is essential in understanding the causes of hyperkalemia as well as its treatment. Renal tubular handling of potassium in children with insulin-dependent diabetes mellitus.

Correction factors have been discussed, but blood usually has to be drawn again [ 30 ]. More effective if given orally. Effect of vasopressin analogue dDAVP on potassium transport in medullary collecting duct.

It modulates excretion of not only potassium but also calcium and magnesium. Extrarenal regulatory mechanisms of potassium metabolism Acid-base balance can affect the balance between cellular and extracellular potassium concentration. Hyperkalemic distal renal tubular acidosis associated hyperkalmia obstructive uropathy.