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 #hyperkalemia #differential #diagnosis #causes #potassium #high #nephrology
