Hyperkalemia

Congestive Heart Failure (CHF)

Chronic Kidney Disease (CKD)

End Stage Renal Disease (ESRD)

Renin-Angiotensin-Aldosterone (RAAS)

Hyperkalemia is a condition where the level of potassium in the blood is too high. Potassium homeostasis is maintained predominantly by the kidneys. The most common cause of high potassium is impaired kidney function due to acute or chronic kidney failure.

Hyperkalemia may be caused by drugs that interfere with the kidney's ability to excrete potassium, especially drugs that interfere with the renin-angiotensin-aldosterone system (RAAS), such as Angiotensin Converting Enzyme (ACE) Inhibitors, Angiotensin II Receptor Blockers (ARBs),  Aldosterone Antagonists (AA) and Renin Inhibitors. Combinations and higher doses of these drugs as they are frequently used in treatment of CHF and CKD may lead to higher incidences of hyperkalemia.

Hyperkalemia may be diagnosed in two situations:

1. In an Emergency Room patient as primary or secondary reason for hospitalization (acute hyperkalemia)
2. In a patient who has taken drugs that impair the kidney's ability to excrete potassium (chronic hyperkalemia)

The need for treatment in either situation is driven by several factors:

• Serum potassium level
• Rate of potassium increase
• Electrocardiogram findings
• Kidney function status
• Presence and severity of co-morbidities

The main goals of treatment of acute hyperkalemia in the ER are to:

• Stabilize the cell membrane (calcium infusion)
• Shift potassium to the intracellular space (insulin & glucose infusions, B2 agonist infusion or inhalation)
• Eliminate potassium from the body (diuretics, polysterene sulfonate, hemodialysis)

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