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Causes are outlined in Table 1-4; in most cases, hyperkalemia is due to decreased renal K+ excretion. However, increases in dietary K+ intake can have a major effect in susceptible pts, e.g., diabetics with hyporeninemic hypoaldosteronism and chronic kidney disease (CKD). Drugs that impact on the RAA axis are also a major cause of hyperkalemia.
The first priority in the management of hyperkalemia is to assess the need for emergency treatment (ECG changes and/or K+ ≥6.0 mM). This should be followed by a comprehensive workup to determine the cause (Fig. 1-3). History and physical examination should focus on medications (e.g., ACE inhibitors, NSAIDs, trimethoprim/sulfamethoxazole), diet and dietary supplements (e.g., salt substitute), risk factors for acute kidney failure, reduction in urine output, blood pressure, and volume status. Initial laboratory tests should include electrolytes, BUN, creatinine, serum osmolality, Mg2+, and Ca2+, a complete blood count, and urinary pH, osmolality, creatinine, and electrolytes. A urine [Na+] <20 meq/L suggests that distal Na+ delivery is a limiting factor in K+ excretion; volume repletion with 0.9% saline or treatment with furosemide may then be effective in reducing serum [K+] by increasing distal Na+ delivery. Serum and urine osmolality are required for calculation of the TTKG. The expected values of the TTKG are largely based on historic data: <3 in the presence of hypokalemia and >7–8 in the presence of hyperkalemia.
The diagnostic approach to hyperkalemia. See text for details. ACEI, angiotensin-converting enzyme inhibitor; acute GN, acute glomerulonephritis; ARB, angiotensin II receptor blocker; ECV, effective circulatory volume; LMW heparin, low-molecular-weight heparin; PHA, pseudohypoaldosteronism; TTKG, transtubular potassium gradient. (Reprinted with permission from Mount DB, Zandi-Nejad K: Disorders of potassium balance. In: Brenner and Rector’s The Kidney, 8th ed, Brenner BM [ed]. Philadelphia, Saunders, 2008.)
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Loscalzo, Joseph, et al., editors. "HYPERKALEMIA." Harrison's Manual of Medicine, 19th ed., McGraw Hill Inc., 2017. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623469/all/HYPERKALEMIA.
HYPERKALEMIA. In: Loscalzo J, Jameson JL, Longo DL, et al, eds. Harrison's Manual of Medicine. 19th ed. McGraw Hill Inc.; 2017. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623469/all/HYPERKALEMIA. Accessed December 6, 2019.
HYPERKALEMIA. (2017). In Loscalzo, J., Jameson, J. L., Longo, D. L., Hauser, S. L., Fauci, A. S., & Kasper, D. L. (Eds.), Harrison's Manual of Medicine. Available from https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623469/all/HYPERKALEMIA
HYPERKALEMIA [Internet]. In: Loscalzo J, Jameson JL, Longo DL, Hauser SL, Fauci AS, Kasper DL, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2017. [cited 2019 December 06]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623469/all/HYPERKALEMIA.
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DB - Harrison's Manual of Medicine
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