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Hyperkalaemia

Definition:

  • Hyperkalemia is a condition characterized by an abnormally high concentration of potassium in the blood. Potassium is a critical electrolyte necessary for the normal function of nerve and muscle cells, particularly heart muscle cells.

Normal Potassium Levels:

  • Typically range from 3.5 to 5.0 mmol/L.
  • Hyperkalemia is generally defined as a serum potassium level greater than 5.0 mmol/L.

Etiology:

  • Reduced renal excretion due to acute or chronic kidney disease.
  • Medications that affect renal potassium excretion (e.g., ACE inhibitors, NSAIDs, potassium-sparing diuretics).
  • Excessive potassium intake (less common).
  • Cellular release of potassium in response to tissue breakdown, acidosis, or hyperglycemia.

Pathophysiology:

  • High potassium levels can disrupt cellular electrical activity, especially in the heart, leading to cardiac rhythm disturbances.

Clinical Features:

  • Often asymptomatic, particularly in mild cases.
  • Muscle weakness, fatigue, and paralysis with severe hyperkalemia.
  • Cardiac manifestations include palpitations, arrhythmias, and in severe cases, cardiac arrest.

Diagnosis:

  • Serum potassium measurement.
  • ECG changes can provide early indications of hyperkalemia (e.g., peaked T waves, widened QRS complex, PR interval prolongation).
  • Assessment of renal function and medications.
  • Evaluate for contributing factors such as acidosis or cellular breakdown.

Management:

  • Acute management depends on the severity and the presence of ECG changes.
  • Calcium gluconate to stabilize the myocardial membrane.
  • Insulin with glucose, Ī²2 agonists, or sodium bicarbonate to shift potassium into cells.
  • Diuretics, cation exchange resins, or dialysis to remove potassium from the body.
  • Addressing underlying causes.

Prevention:

  • Monitoring potassium levels in at-risk patients.
  • Judicious use of medications that impact potassium levels, especially in patients with renal impairment.
  • Dietary potassium restriction in patients with chronic kidney disease.

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