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Hyperkalemia - Differential Diagnosis - Impaired Excretion vs Redistribution

Impaired Urinary Excretion 
 - Renal failure
 -
Hyperkalemia - Differential ... Diagnosis - Impaired Excretion ... Impaired Urinary Excretion ... - Exercise - Hyperkalemic ... DrEricStrong #Hyperkalemia
Causes of Hyperkalemia - Differential Diagnosis Algorithm
 • Increased Intake
 • Reduced Excretion (IV potassium with
Causes of Hyperkalemia ... Intake • Reduced Excretion ... potassium with reduced excretion ... Transcellular Shift #Hyperkalemia
Causes of Hyperkalemia

Hyperkalemia is caused by excess potassium intake, impaired potassium excretion, or transcellular shifts. The
Causes of Hyperkalemia ... Hyperkalemia ... impaired potassium excretion ... The etiology of hyperkalemia ... by increasing excretion
►
Electrolyte imbalances are common findings in many diseases. The kidney is a principally responsible organ for
retention and excretion ... #Hyponatremia #hypokalemia ... hypernatremia #hyperkalemia ... #hypercalcemia
Causes of Hyperkalemia - Differential Diagnosis Framework
 • Cellular Shift:
   - Exercise
Causes of Hyperkalemia ... tacrolimus - Hyperkalemic ... Decreased Urinary Excretion ... Hemolysis • Pseudo hyperkalemia ... Medicine @ucsdim #Hyperkalemia
Pathophysiology of Tumor Lysis Syndrome (TLS)
Tumor Cell Lysis
-> Release of DNA
 • Purines -> Hypoxanthine /
Acid (low urinary excretion ... (High urinary excretion ... Hypocalcemia • Hyperkalemia
Causes of Hyperkalemia
Pseudohyperkalemia
 - Tourniquet use
 - Hemolysis (in vitro)
 - Leukocytosis
 - Thrombocytosis
Intra- to extracellular
Causes of Hyperkalemia ... intoxication - Hyperkalemic ... Decreased potassium excretion ... renal potassium excretion ... acidosis) #Hyperkalemia
Blood pressure
Renin
ACTH
Angiotensin Il
Zona glomerulosa
Secretion
Physical activity, stress
Adrenal
#Epinephrine
#Adrenalmedulla
Degradation
Glucuronation in the liver
Excretion
Bile
Feces
#Hyperkalemia
#Aldosterone
Na* retention and
K* excretion in:
Salivary glands
#Sweat glands
#Gallbladder
Nat
Na
K*
Kidney
Colon
Zona glomerulosa Secretion ... in the liver Excretion ... Bile Feces #Hyperkalemia ... retention and K* excretion
Causes of Hypercalcemia
Hypercalcemia due to increased bone Ca2+ resorption:
 • Primary hyperparathyroidism, Malignancy, Pseudohyperparathyroidism, Renal failure,
Causes of Hypercalcemia ... Hypercalcemia ... Immobilization Hypercalcemia ... decreased urinary Ca2+ excretion ... intoxication #Hypercalcemia
Hyperkalemia Treatment Options
Stabilize cardiac membrane:
 • IV Calcium (peaks 5-10 minutes)
Decrease potassium concentration:
 • IV Fluids
Shift
Hyperkalemia Treatment ... bicarbonate Potassium excretion ... LouLectures #Hyperkalemia