Causes of Hyperkalemia
l. Pseudohyperkalemia
A Cellular efflux; thrombocytosis, erythrocytosis, leukocytosis, in vitro hemolysis
B. Hereditary defects in red cell membrane transport
II. Intra- to extracellular shift
A. Acidosis
B. Hyperosmolality; radiocontrast, hypertonic dextrose, mannitol
C. Beta-Adrenergic antagonists (noncardioselective agents)
D. Digoxin and related glycosides (yellow oleander, foxglove, bufadienolide)
E. Hyperkalemic periodic paralysis
F. Lysine, arginine, and E-aminocaproic acid (structurally similar, positively charged)
G. Succinylcholine; thermal trauma, neuromuscular injury, disuse atrophy, mucositis, or prolonged immobilization
H. Rapid tumor lysis
IIl. Inadequate excretion
A. Inhibition of the renin-angiotensin-aldosterone axis; T risk of hyperkalemia when used in combination
1. Angiotensin-converting enzyme (ACE) inhibitors
2. Renin inhibitors; aliskiren (in combination with ACE inhibitors or angiotensin receptor blockers [ARBs])
3. Angiotensin receptor blockers (ARBs)
4. Blockade of the mineralocorticoid receptor: spironolactone, eplerenone, drospirenone
5. Blockade of the epithelial sodium channel (ENaC): amiloride, triamterene, trimethoprim, pentamidine, nafamostat
B. Decreased distal delivery
1. Congestive heart failure
2. Volume depletion
C. Hyporeninemic hypoaldosteronism
1. Tubulointerstitial diseases: syßtemic lupus erythematosus (SLE), sickle cell anemia, obstructive uropathy
2. Diabetes, diabetic nephropathy
3. Drugs: nonsteroidal anti-inflammatory drugs (NSAlDs), cyclooxygenase 2 (COX2) inhibitors, ß-blockers, cyclosporine, tacrolimus
4. Chronic kidney disease, advanced age
5. Pseudohypoaldosteronism type II
D. Renal resistance to mineralocorticoid
1. Tubulointerstitial diseases: SLE, amyloidosis, sickle cell anemia, obstructive uropathy, post-acute tubular necrosis
2. Hereditary: pseudohypoaldosteronism type l; defects in the mineralocorticoid receptor or the epithelial sodium channel (ENaC)
E. Advanced renal insufficiency
1. Chronic kidney disease
2. End-stage renal disease
3. Acute oliguric kidney injury
F. Primary adrenal insufficiency
1. Autoimmune: Addison's disease, polyglandular endocrinopathy
2. Infectious: HIV, cytomegalovirus, tuberculosis, disseminated fungal infection
3. Infiltrative: amyloidosis, malignancy, metastatic cancer
4. Drug-associated: heparin, low-molecular-weight heparin
5. Hereditary: adrenal hypoplasia congenita, congenital lipoid adrenal hyperplasia, aldosterone synthase deficiency
6. Adrenal hemorrhage or infarction, including in antiphospholipid syndrome
#Hyperkalemia #Differential #Diagnosis #High #Potassium #Classification #Causes
