Hyperkalemia is a dangerous condition caused by excessive potassium in the blood, with symptoms including abnormal heart beat, muscle weakness, and malaise. It can be caused by kidney failure, medication, and excessive potassium intake. Treatment involves emergency lowering of blood potassium and management through medication and diet.
Hyperkalemia is an excessive level of potassium in the blood. It causes symptoms including an abnormal heart beat, muscle weakness and malaise, or a general feeling of discomfort. Because symptoms are often vague, it’s difficult to diagnose, but hyperkalemia can prove fatal if left untreated. Indeed, hyperkalemia is induced to cause death by lethal injection. There are many possible causes of hyperkalemia.
The causes of hyperkalemia fall into three basic categories: insufficient elimination of potassium, excessive release of potassium by the body’s cells, and excessive potassium intake. Ineffective elimination can be caused by kidney failure, certain medications, mineralocorticoid hormone deficiency, or the rare congenital disease arthrogryposis, also called Gordon’s syndrome. Cells in the body can release excess potassium into the bloodstream due to tissue death or breakdown or due to excessive blood transfusion. Excessive potassium intake can be caused by potassium chloride infusion or by intoxication with a salt substitute or potassium-containing dietary supplement.
Blood potassium levels are regulated in a healthy individual by elimination through the urinary system. The kidneys remove potassium and other substances from the blood and excrete them in the urine. Therefore, kidney or urinary system problems are common causes of hyperkalemia. Drugs that interfere with urinary excretion include angiotensin converting enzyme (ACE) inhibitors for hypertension, the antibiotic trimethoprim, the antiparasitic pentamidine, the immunosuppressants cyclosporine and tacrolimus, and nonsteroidal anti-inflammatory drugs (NSAIDs ). Drug discontinuation or modification, when possible, can often cure drug-induced hyperkalemia.
Causes of hyperkalemia involving mineralocorticoid deficiency include Addison’s disease and congenital adrenal hyperplasia, in which the adrenal glands do not produce enough hormones. Type IV renal tubular acidosis, in which the kidneys are resistant to the mineralocorticoid hormone aldosterone, can also cause hyperkalemia. Hyperkalemia is also a common symptom of arthrogryposis, or Gordon syndrome, which also causes joint deformities, high blood pressure, failure to thrive, and breathing problems.
Hyperkalemia is diagnosed through blood tests to identify abnormally high levels of potassium. Repeated tests are needed to make a diagnosis. Acute hyperkalemia is treated with emergency lowering of blood potassium, which can be done by administering calcium, insulin, bicarbonate, or salbutamol. In very severe cases, dialysis may be required.
Hyperkalemia can be managed or prevented by reducing potassium in the diet and through medications, which can take the form of diuretics, calcium polystyrene sulfonate, or sorbitol. However, some diuretics, such as amiloride and spironolactone, do not remove potassium from the body and can themselves cause hyperkalemia. It is important to monitor the medications of a person with hyperkalemia, as many medications can be the source of the disorder.
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