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Hyperkalemia CausesAka: Pseudohyperkalemia, Hyperkalemia due to Decreased Renal Excretion, Hyperkalemia due to Redistribution, Hyperkalemia due to Excessive Potassium Load

See Also
1. Hyperkalemia
2. Medication Causes of Elevated Serum Potassium
Causes: Decreased renal excretion
1. Hypoaldosteronism
  1. Hyporeninemic hypoaldosteronism
    1. Intrinsic renal disease (provoked by dehydration)
    2. Prostaglandin synthetase inhibitors
  2. Primary Hypoaldosteronism
  3. Medication
    1. Heparin
    2. Cyclosporine
    3. ACE Inhibitor
  4. Adrenal Insufficiency (volume low, decreased GFR)
2. Renal Insufficiency or Renal Failure
3. Renal Tubular Acidosis (Type 4)
4. Congestive Heart Failure
  1. Decreased distal nephron sodium delivery
5. Potassium sparing Diuretics
6. Heparin
7. NSAIDS
8. Tubular unresponsiveness to aldosterone
Causes: Redistribution (ICF to ECF)
1. Acidosis (more likely with mineral acids NH4, HCl)
2. Hyperkalemic periodic paralysis
3. Insulin deficiency (Diabetes Mellitus)
4. Rapid ECF rise
  1. Hypertonic glucose or mannitol infused
5. Dialysis
6. Coronary bypass
7. Medications
  1. Succinylcholine (if concurrent tissue damage)
  2. Beta Blockers
  3. Digitalis intoxication (Digoxin Toxicity)
  4. Arginine
8. Tissue necrosis or Burn Injury
Causes: Potassium load
1. Oral or IV Potassium Supplementation
2. Salt substitute
3. Blood transfusion
4. High dose Penicillin (1.7 meq K+ per 1 Million Units)
5. Endogenous
  1. Tumor lysis
  2. Burn injury
  3. Crush injury
6. Massive Hemolysis
7. Surgery
8. Gastrointestinal Bleeding
Causes: Pseudohyperkalemia (Actual Serum Potassium less than lab)
1. Blood sample clotted
2. Delayed analysis or other lab error
3. Excessive tourniquet or fist clenched repeatedly
4. Hemolysis via small needle or traumatic venipuncture
5. Severe Thrombocytosis
6. Severe Leukocytosis
References
1. Gibbs in Marx (2002) Rosen's Emerg Med, p. 1730-1
2. Klahr (2001) in Noble (2001) Primary Care p. 1359-62

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.