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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Acid-base balance can affect the balance between cellular and extracellular potassium concentration. This article has been cited by other articles in PMC. In the presence of renal failure, the proportion hyperkale,ia potassium excreted through the gut can increase, but is subject to high inter-individual variability [ 1 ]. Potassium is filtered in the glomerulus and almost completely reabsorbed in the proximal tubule and the loop of Henle.

Diagnosis of hyperkalemia Hyperkalemia can be classified according to serum potassium into mild 5. Margassery S, Bastani B.

Pathogenesis, diagnosis and management of hyperkalemia

Especially in pediatrics, hyperaklemia hemolysis can occur during difficult blood draws, and even more in samples with lymphocytosis or thrombocytosis. Treatment has to be initiated immediately using different therapeutic strategies hyperkalemoa increase potassium shift into the intracellular space or to increase elimination, together with reduction of intake.


Combined treatment with spironolactone and ACE inhibitors, especially in patients with renal impairment or heart failure, has to hyperkaleemia monitored very carefully. 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. Acute increase in osmolality secondary to hyperglycemia or mannitol infusion causes potassium to exit from cells [ 24 ].

Leakage of potassium out of cells through depolarization of cell membranes.

Effect of vasopressin analogue dDAVP on potassium transport in medullary collecting duct. National Center for Biotechnology InformationU. N Engl J Med. Symptoms are non-specific and predominantly related to muscular or cardiac dysfunction.

Pathogenesis, diagnosis and management of hyperkalemia

Clin J Am Soc Nephrol. Neum, beta hydroxylase or hydroxylase or OH progesterone in plasma. Effective treatment of acute hyperkalaemia in childhood by short-term infusion of salbutamol. This can be the case in patients with rhabdomyolysis, tumorlyis, hemolysis, or after massive transfusion.

However, moderate and especially severe hyperkalemia can lead to disturbances of cardiac rhythm, which can be fatal [ 2829 ]. An inappropriately low TTKG in a hyperkalemic patient suggests hypoaldosteronism or a renal tubule defect [ 39 ].

Oxford University Press, p Renal tubular handling of potassium in children with insulin-dependent diabetes mellitus. Diarrhea if preparations come premixed with sorbitol. Addison or secondary e. It can be caused by reduced renal excretion, excessive intake or leakage of potassium from the intracellular space. The particular phenotype and degree of hyperkalemia depends on the sex of the individual, the location of the block in synthesis, and the severity of the genetic deletion or mutation. Absorption of potassium from the gastrointestinal tract is rapid and usually complete.


Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas hypeekalemia a gram infant with hyperkalemia. J Am Coll Nutr.

Human cortical distal nephron: Salbutamol has been shown to be safe and even superior to rectal cation-exchange resin in nonoliguric preterms with hyperkalemia [ 34 ]. Potassium homeostasis and Renin-Angiotensin-aldosterone system inhibitors. Hyperkalemia is rarely associated with symptoms, occasionally patients complain of palpitations, nausea, muscle pain, or paresthesia.

PHA type I caused by autosomal dominant mutations in the human mineralocorticoid receptor MR gene is limited to the kidneys.

The utility of the transtubular potassium gradient in the evaluation of hyperkalemia.