Hyperkalemia

Hyperkalemia occurs when serum potassium levels exceed 5.5 mmol/L, usually due to impaired renal excretion, increased potassium intake, or a shift of potassium from inside cells to the extracellular space. This electrolyte imbalance can trigger neuromuscular symptoms and serious cardiac arrhythmias, especially when levels rise above 6.5 mmol/L.

How common is hyperkalemia?

Hyperkalemia affects under 5% of the general population but rises to approximately 10% among hospitalized patients, with prevalence tending to be higher in men than in women.

What symptoms are commonly associated with hyperkalemia?

Common symptoms of hyperkalemia are often mild or absent, with subtle signs that may be overlooked. These can develop gradually over weeks or months and include abdominal discomfort, diarrhea, nausea, or vomiting. In severe cases, hyperkalemia can lead to acute cardiac complications. Patients may present with chest pain, palpitations, arrhythmias (such as irregular, rapid, or fluttering heartbeats), and muscle weakness or numbness in the limbs.

What causes hyperkalemia?

Causes of hyperkalemia vary, but high potassium levels often become more problematic in people with advanced kidney disease. Medications, supplements, and salt substitutes containing potassium or interfering with its regulation can contribute. Diet is a factor – while most people tolerate potassium-rich foods, those with impaired kidney function may struggle to clear excess potassium. Conditions like diabetes and heart failure also disrupt potassium balance by damaging the kidneys or altering hormone levels that control excretion.

How is hyperkalemia treated?

Hyperkalemia is treated by stabilizing cardiac membranes with intravenous calcium gluconate, shifting potassium into cells using insulin with glucose, albuterol, or sodium bicarbonate, and promoting potassium elimination through loop diuretics or potassium binders (patiromer, sodium polystyrene sulfonate, and sodium zirconium cyclosilicate). In severe cases, dialysis may be required to rapidly remove excess potassium.

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