In hyperkalemia, the potassium level in the blood is too high.

A high potassium level has many causes, u. a. Kidney disease, drugs that affect kidney function, and the consumption of too much potassium supplements.

Normally, an excess of potassium must be severe before it leads to symptoms, mainly cardiac arrhythmias.

Doctors usually detect a potassium excess in blood tests or an electrocardiogram for other reasons.

Treatment includes reduction of potassium intake, discontinuation of drugs that can cause an excess of potassium, and the use of potassium enhancement drugs.

Potassium is one of the electrolytes in the body. These are minerals that carry an electrical charge when dissolved in body fluids such as the blood. The body needs potassium for the function of nerve and muscle cells, but too much potassium may impair its function.

Causes of hyperkalemia
Normally, there is a surplus of potassium due to several co-existing problems, including:

Kidney diseases that prevent the kidneys from secreting enough potassium

Medicines that prevent the kidneys from excreting potassium in normal amounts (a common cause of a slight excess of potassium)

A potassium-rich diet

Potassium-containing treatments

The most common cause of a slight e┬áis the intake of medicines that lower the blood flow in the kidneys or prevent the kidneys from releasing enough potassium. Renal failure can itself cause a substantial excess of potassium. Addison’s disease can also cause excess potassium.

An excess of potassium can develop after large amounts of potassium have been released from the cells. The rapid transfer of potassium from the cells into the blood can overwhelm the kidneys and lead to a life-threatening excess of potassium.

Excessive intake of potassium on its own does not often result in excess of potassium, because healthy kidneys can excrete excess potassium well.

What causes the potassium level to rise?

  • Medicines or other circumstances
  • A reduced excretion in the urine
  • Kidney failure
  • Aliskiren
  • Angiotensin-converting enzyme inhibitors (ACE inhibitors)
  • Angiotensin receptor blockers
  • Cyclosporine (to prevent rejection of organ transplants)
  • Diuretics that aid the kidney in the preservation of potassium, eg. Eplerenone, spironolactone, and triamterene
  • Non-steroidal anti-inflammatory drugs
  • Tacrolimus (to prevent rejection of organ transplants)
  • Trimethoprim (an antibiotic)
  • The release of potassium from the cells
  • Heavy burns
  • Bruises
  • Muscle loss (rhabdomyolysis)
  • Diabetes mellitus (especially ketoacidosis)
  • Metabolic acidosis
  • Beta-blocker
  • Cancer chemotherapy
  • A healthy and more extended physical effort
  • Increased consumption
  • A potassium-rich diet (like beans, dark green leafy vegetables, potatoes, fish, and bananas)
  • Potassium supplements
    Intravenous potassium-containing treatments, eg. Parenteral nutrition and blood transfusions

Symptoms of hyperkalemia
A slight excess of potassium rarely causes symptoms, if any. Sometimes patients may develop muscle weakness. In a rare condition called familial periodic paralysis, sufferers experience gaps that can lead to disease.

If a potassium excess grows more severe, it can cause cardiac arrhythmias. At very high levels of potassium, a cardiac arrest is imminent.

Diagnosis of hyperkalemia
Measurement of the potassium level in the blood

An excess of potassium is usually detected during routine blood tests or specific changes in the electrocardiogram (ECG).

To determine the cause, the doctors review the patient’s medical history of which medicines they are taking and conduct blood tests to find evidence of diabetes mellitus, acidosis, muscle breakdown or kidney disease.

Treatment of hyperkalemia
Drugs to increase potassium excretion

The disease that causes the potassium excess is treated.

Mild hyperkalemia
With a slight excess of potassium, a reduction in potassium intake or withdrawal of medicinal products that inhibit the kidneys from excreting potassium may be sufficient. If renal function is normal, a diuretic may also be given to increase potassium excretion. If necessary, a resin may be administered orally or as an enema that binds potassium from the digestive tract and excretes it with the stool. Sodium polystyrene sulfonate is a resin that effectively absorbs potassium but is used only for a short time because it can lead to the storage of excess sodium. Patiromer is a new resin-based drug that can be used for a long time. It is useful in people who need medication that usually raises potassium levels, such as: Angiotensin-converting enzyme (ACE) inhibitors used to treat heart or kidney disease.

Moderate to severe hyperkalemia
With medium to large levels of excess potassium, the treatment plan is typically to lower the postaissium level immediately. Phyiscians often monitor the heart during treatment. Calcium is given intravenously to protect the heart. However, this does not lower the potassium level. Then insulin and glucose are administered, which transport potassium from the blood into the cells and thus lower the potassium level in the blood. Salbutamol (used primarily for the treatment of asthma) can be administered to better lower potassium levels. It is inhaled.

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