Internal Medicine – Hyperkalemia: By Ben Schelew M.D.


Potassium is a naturally occurring element with an atomic number of 19. It is the major positive ion inside animal cells. Potassium is critical for several physiologic functions including neurotransmission, muscle contraction, and heart function.

If potassium levels become too high – a condition called hyperkalemia – many of the body’s functions can become dysfunctional. Because this is a potentially lethal condition, hyperkalemia is something that you cannot afford to miss. Our bodies have a large store of potassium but we require dietary intake to maintain safe levels. Our kidneys filter potassium, then secrete or reabsorb it depending on our body’s need. The causes of hyperkalemia can be divided into three main categories: Dietary intake can be excessive (too much in); Renal impairment can result in accumulation (not enough out); or The ion can be transferred out of cells (shift). Excessive intake is rare and really limited to iatrogenic causes – or caused by medical intervention.

For instance, the overtreatment of hypokalemia by overshooting desired potassium levels is a cause. Eating foods that are rich in potassium, like bananas, is not a cause. In fact, even though monkeys love bananas, they manage to avoid hyperkalemia! Renal causes are a common cause of hyperkalemia. These may include acute or chronic renal failure and deficiencies of the hormone aldosterone, which regulates potassium levels – as in Addison’s disease. Other things that can affect renal function – like the effect of drugs on glomerular filtration, as in the case of NSAIDs, ACE inhibitors, ARBs, or potassium sparing diuretics like spironolactone or amiloride – can also cause high levels of potassium. Finally, potassium can be released from cells into the serum.

This can happen due to tissue damage like rhabdomyolysis, burns, or necrosis from blood cells during a massive transfusion or hemolysis, or transported out of cells in the case of acidosis, low insulin levels or beta-blocker therapy. There are really no signs or symptoms of hyperkalemia. The ECG may show signs of hyperkalemia, including small P waves, peaked T waves, progressing to widened QRS, and finally a sinusoidal shape. The most impactful therapy of hyperkalemia is CALCIUM! Calcium stabilizes the myocardium preventing fibrillation.

Internal Medicine – Hyperkalemia: By Ben Schelew M.D.

One gram of calcium chloride or calcium gluconate is administered intravenously every few minutes until the ECG reverts to normal. Then one can work on shifting it back into cells with insulin or ventolin, or ridding it from the body with diuretics or using dialysis.


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