Hyperkalemia - Differential Diagnosis Framework

PseudoHyperkalemia:
 • Lab error
 • Traumatic venipuncture
 • Hemolysis, thrombocytosis, leukocytosis
 • Clenching of fist during phlebotomy

High Suspicion for Hyperkalemia:
 • CKD
 • Poorly controlled DM
 • Chemotherapy
 • Burns
 • Trauma/Crush injury
 • Blood transfusion
 • HTN and edema
 • Jaundice/Hemolytic reactions

Common Drugs Causing Hyperkalemia:
 • Digoxin
 • K sparing diuretics
 • NSAIDs
 • ACE Inhibitors
 • Recent IV potassium
 • Beta blockers
 • Antibiotics: amoxicillin
 • Heparins
 • Tacrolimus
 • TMP-SMZ
 • Penicillin G

Intracellular Shift:
 • K release due to cell lysis:
	- Hemolysis
	- Transfusion reaction
	- Tumor lysis syndrome
	- Rhabdomyolysis, burns, trauma
	- Ischemic colonic necrosis
 • K release with intact cell membrane
	- Beta adrenergic receptor blockers
	- Succinylcholine
	- Hyperosmolar states (Uncontrolled diabetes, glucose infusions)
	- Metabolic acidosis
	- Hyperkalemia Periodic paralysis
	- Insulin deficiency or resistance

Impaired Renal Excretion:
 • Addison’s disease/Hypoaldosteronism
 • Acquired hyporeninemic hypoaldosteronism
 • Mineralocorticoid deficiency
 • Renal insufficiency/Failure
 • SLE
 • Type IV RTA
 • Renal hypoperfusion

Increased K Intake:
 1. Medications
 2. K supplement
 3. Blood transfusion
 4. TPN
 5. Food - Avoid in CRF: 
	• Dried fruits, Seaweed, Nuts, molasses, Avocados, Lima beans
	• Vegetables: spinach, potatoes, tomatoes, broccoli, carrots
	• Fruits: kiwis, mangoes, oranges, bananas, cantaloupe

Updated Version Here: https://www.grepmed.com/images/1283

#hyperkalemia #differential #diagnosis #causes #potassium #high #nephrology
Ravi Singh K @rav7ks · 4 years ago
Academic Hospitalist and Program Director @SinaiBmoreIMRes, Medicine clerkship director GW School of Medicine and Health Sciences RMC at Sinai, Clinical reasoning,Simulation and POCUS enthusiast - https://twitter.com/rav7ks
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