Hyperkalemia

Defining Hyperkalemia

When the potassium levels in the blood are extremely high, one is said to have the hyperkalemia condition. When these levels exceed measure, one can easily die from abnormal heartbeats. The normal range of potassium in the blood lies between 3.5 to 5.5.mEq/L for adults.


Levels higher than these are likely to interfere with neurological and hemodynamic functions but in extreme cases, cardiac arrest. Even though potassium is a necessary nutrient, it should be consumed in proportions that will ensure it remains in the right measure [1,3,5].

Hyperkalemia Signs and Symptoms

How do you know you are suffering from Hyperkalemia? Hyperkalemia does not present obvious symptoms and thus most patients are unaware that they have this condition until it is either too late or they are undergoing other tests of which potassium level is tested.

However, like most other diseases, there are some tell-a-tale signs that could lead one into more testing [10]. These include

  • Dyspnea, this is the condition where the patient will have trouble breathing, mostly having short breaths even when not carrying out tasks. The patient may become breathless for apparently short walks or climbing stairs, a task previously completed effortlessly.
  • Chest Pains There is a presence of increased pains along the thoracic region.
  • Palpitations These are quick and irregular heartbeats usually forceful and are an indicator of something wrong in the body
  • Muscle Weakness Patients exhibit general lethargy claiming of muscle weaknesses and may be unable to carry out simple life tasks.
  • Nausea and vomiting, extreme nausea will be accompanied by vomiting even when those suffering have not had anything to eat, or eaten anything new. This will be prolonged and do not wane even with simple remedies
  • Parenthesis, this is tingling or prickly feeling as though one is being prickled with needles. There will also be a remarkable sensation that is abnormally sensitive usually caused by pressure to the peripheral nerves.

Pathophysiology of hyperkalemia

  • Presence of potassium in the electrolytes, which is part of our blood, plays a unique role in the formulation and circulation of body fluids. As indicated, the normal levels of potassium in adults are 3.5 to 5.5m/Eq/L. beyond 5.5 is referred to as hyperkalemia while below 3.5 is hypokalemia [4]. Both hyper or hypokalemia are life threatening.
  • Potassium may be housed in the cells but also form a part of the intercellular fluid such as blood. Therefore, potassium’s presence is essential in that its total concentration determines if it will stick inside the cell or it is a free flow.
  • It also helps in maintaining the cell fluid volume.
  • Potassium is also an ingredient used in transmitting of communication links to the nerves.
  • Foods rich in potassium include tomatoes, meats and bananas, though best when ripe as well the orange fruit.
  • Regulation of this vital nutrient is through determined intakes, relative distribution between the cell region as well as extracellular. Excretion also forms an integral part in maintaining the right potassium volumes.
  • Elimination of excessive potassium is often through the kidneys, sweating as well as through the gastrointestinal tract. Aldosterone hormones are useful in the excreting processes.

Causes of Hyperkalemia

  • Some of the most common causes of genuine hyperkalemia (Sometimes hyperkalemia may be diagnosed due to potassium levels found in a blood sample. The cause of the heightened levels may be caused by the broken cells when piercing is to get the blood sample and thus not truly right. Hyperkalemia should be in conjunction with other related signs and symptoms) is kidney ailments;

Chronic kidney disease (Kidney failure)

  • Alcoholism
  • Excessive drugs use
  • Injuries that cause destruction of the red blood cells
  • Body burns that causes acute cell-tissue damages
  • Type 1 diabetes
  • Acidosis
  • Adrenal failure
  • Angiotensin, (a protein when in the blood stream raises the pressure and also advances aldosterone secretion) imbalances

Determining if one has hyperkalemia

Since it is difficult to tell obvious signs of Hyperkalemia, one should therefore request for a check-up if they suspect its presence. Thankfully, potassium level in the blood stream is one of the components of most blood related checkups. This will most likely attract a medical intervention should their levels be elevated beyond normal ranges.

It is however important to note that potassium levels checkups are done repeatedly as homeostasis can present the wrong indications. This is because of the rapturing of the blood cells during the actual drawing of the blood sample. This is referred to as pseudo hyperkalemia. However, other methods of determining hyperkalemia are

Hyperkalemia ECG (EKG)

  • Electrocardiography or ECG, the results of a patient suffering from hyperkalemia will have
    Elevated or tall T Waves
  • QT interval is short.
  • The PR interval will however be lengthened,
  • Loss in P waves
  • Widened QRS will culminate in morphology that takes a sine wave and left unattended, leads to death.

For patients with highly elevated potassium quantities, this brings about palpitations or other cardiac complications that result in fatality. Generally, potassium acts as the general regulator of electrical activities in the heart.

A peaked T wave is one of the obvious elements of the presence of hyperkalemia. However, this alone does not present the severity of the disease and other further examinations are required [9].

  • Medical examinations that may include doctor’s determination of historical occurrences of hyperkalemia related symptoms.
  • Laboratory Investigations, this will include;
  1. Kidney functions checks,
  2. Urinary tract infections,
  3. Cardiac functions,
  4. Level amounts of hydration.
  5. Blood Urea Nitrogen as well as Creatinine levels so as to determine the renal status
  6. If there is determined renal failure, confirm the calcium levels
  7. If on digitalis medication, confirm the digoxin levels
  8. Where acidosis is suspected, checks for arterial or any venous blood gas
  9. Where all other above is eliminated, confirm the Cortisol and aldosterone levels

Treatment for Hyperkalemia

Treating hyperkalemia is dependent on the most aggressive symptoms as well as the patient’s present condition and level of tolerance.

  • Elimination of potassium; excretion of urinary potassium is usually impaired by either Chronic Kidney Disease (CKD) or any drugs of disorders that impede renin angiotensin aldosterone axis. At such times, elimination of potassium involves reducing potassium out of the cells even though this may hamper even the necessary potassium levels in the body. This is especially when there is uncontrolled hyperglycemia. The insulin deficiency in this case is the primary determinant in potassium trans-cellular shifting. The potassium moves from the cells to the extracellular fluid [6,7].
  • For such conditions, administration of insulin and fluids reverses the movement of potassium to the extracellular fluids. This process should however be closely monitored to prevent reducing the potassium levels to a point of causing hypokalemia, which is the too much lowering of useful potassium.
  • Administration of Albuterol Sulfate, 0.5mg in chronic renal failure patients is necessary for lowering the potassium. Elimination may be through cation or diuretics for those who have no cardio related complexities or those with no renal complications. Those with renal conditions either about to undergo dialysis or transplanting are better administered orally.
  • Correcting the abnormality in potassium levels, this is done by finding out the cause of the potassium increase and managing it.
  • Calcium is also recommended for enhance and regulate the cardiac toxicity. Administration of calcium is better intravenously.
  • Sodium Bicarbonate is used to correct severe metabolic acidosis, a condition where there is elevated acid content in the body fluids and tissue.
  • Surgery is recommended only on certain cases and as a last result. This is often endorsed for;
  1. Severe acidosis
  2. Rhabdomyolysis hyperkalemia, where the ischemic muscles are swollen
  3. Patients who will need Hemodialysis and are not at the last stages of renal failure

Prevention of Hyperkalemia

Hyperkalemia is largely preventable through [7]

  • Reducing the potassium in your diet or
  • Reducing any medication that may be causing the rise of the potassium levels.
  • Engaging the use of a regular mild diuretic such as furosemide; for the maintenance of ideal levels of potassium.

References

  1. Pergola PE, DeFronzo R. Clinical disorders of hyperkalemia. In: The Kidney: Physiology and Pathophysiology, Seldin DW, Giebisch G (Eds), Lippincott Williams & Wilkins, 2000. Vol 2, p.1647.
  2. Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int 1990; 38:869.
  3. Goldfarb S, Strunk B, Singer I, Goldberg M. Paradoxical glucose-induced hyperkalemia. Combined aldosterone-insulin deficiency. Am J Med 1975; 59:744.
  4. Blumberg A, Weidmann P, Shaw S, Gnädinger M. Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure. Am J Med 1988; 85:507.
  5. Ettinger, P O, T J Regan, and H A Oldewurtel. 1974. Hyperkalemia, cardiac conduction, and the electrocardiogram: a review. American heart journal, no. 3.http://www.ncbi.nlm.nih.gov/pubmed/4604546.
  6. Weisberg, Lawrence S. 2008. Management of severe hyperkalemia. Critical care medicine, no. 12. doi:10.1097/CCM.0b013e31818f222b.http://www.ncbi.nlm.nih.gov/pubmed/18936701.
  7. Wrenn, K D, C M Slovis, and B S Slovis. 1991. The ability of physicians to predict hyperkalemia from the ECG. Annals of emergency medicine, no. 11.http://www.ncbi.nlm.nih.gov/pubmed/1952310.
  8. Webster A, Brady W, Morris F. Recognising signs of danger: EKG changes resulting from an abnormal serum potassium concentration. Emerg Med J. 2002 Jan 19;19(1):74–7. DOI:http://dx.doi.org/10.1136/emj.19.1.74. [PMC free article] [PubMed]
  9. Diercks DB, Shumaik GM, Harrigan RA, Brady WJ, Chan TC. Electrocardiographic manifestations: electrolyte abnormalities. J Emerg Med. 2004 Aug;27(2):153–60. DOI:http://dx.doi.org/10.1016/j.jemermed.2004.04.006. [PubMed]
  10. Hampton, JR. The ECG in Practice (5th edition), Churchill Livingstone 2008.

Published on by under Diseases and Conditions.
Article was last reviewed on September 11th, 2016.



Leave a Reply

Back to Top