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Hyperkalemia - Differential Diagnosis Framework

PseudoHyperkalemia:
 • Lab error
 • Traumatic venipuncture
 • Hemolysis, thrombocytosis, leukocytosis
 •
phlebotomy High ... • NSAIDs • ACE ... • Recent IV potassium ... diagnosis #causes #potassium ... #high #nephrology
Hyperkalemia - Differential Diagnosis Framework

PseudoHyperkalemia:
 • Lab error
 • Traumatic venipuncture
 • Hemolysis, thrombocytosis, leukocytosis
 •
phlebotomy High ... • NSAIDs • ACE ... • Recent IV potassium ... diagnosis #causes #potassium ... #high #nephrology
Causes of High-anion Gap and Non-anion Gap Metabolic Acidosis
Causes of High-anion Gap Acidosis:
 • Lactic acidosis
Causes of High-anion ... Acidosis Causes of High-anion ... Potassium-sparing ... ACE-Is and ARBs
ACEI Antihypertensive Dose Comparison. Consider divided (BID) regimen for better pre-dose (trough) BP control for the
ACEI Antihypertensive ... the following ACEIs ... Monitor BP, potassium ... #ACEInhibitor #ACEIs
Causes of Hyperkalemia
l. Pseudohyperkalemia
  A Cellular efflux; thrombocytosis, erythrocytosis, leukocytosis, in vitro hemolysis
  B.
Angiotensin-converting enzyme (ACE ... combination with ACE ... Differential #Diagnosis #High ... #Potassium #Classification
Hyperkalemia: Diagnostic algorithm
Decreased renal potassium excretion
 • Acute renal failure
 • Chronic renal failure
 • Drugs
Increased
Decreased renal potassium ... Drugs Increased potassium ... (oral/iv) • Potassium-rich ... Normal, Renin High ... hypoplasia Aldosterone high
Lisinopril - ACE inhibitor used for the treatment of hypertension and heart failure. 3rd most prescribed
Lisinopril - ACE ... Prinivil #Qbrelis #ACEI
Blood Transfusion Reactions

Immune Mediated:
 • Febrile Non-Hemolytic Transfusion Reaction (FNHTR): Most common immune reaction to transfusion.
High mortality. ... products contain potassium ... People taking ACEi
Drugs that Impair Renal Potassium Excretion 

Decreased ENaC channel function: Amiloride, Triamterene, Pentamidine
Decreased Aldosterone Synthesis: Heparin,
that Impair Renal Potassium ... Aldosterone Release: ACE ... Pharmacology #Impaired #Potassium
Here’s a review of the Renin-Angiotensin-Aldosterone system (RAAS)

This is a very common pathway that clinicians should
with excreting potassium ... classes (Aliskiren, ACEI ... while retaining potassium ... will increase potassium ... , which is why potassium