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A Physiologic-Based Approach to the Evaluation of a Patient With Hyperkalemia

Authors
Journal
American Journal of Kidney Diseases
0272-6386
Publisher
Elsevier
Publication Date
Volume
56
Issue
2
Identifiers
DOI: 10.1053/j.ajkd.2010.01.020
Keywords
  • Hyperkalemia
  • Cell Shift
  • Abnormal Collecting Duct
  • Pseudohyperkalemia
  • Impaired Renal Potassium Excretion

Abstract

Hyperkalemia generally is attributable to cell shifts or abnormal renal potassium excretion. Cell shifts account for transient increases in serum potassium levels, whereas sustained hyperkalemia generally is caused by decreased renal potassium excretion. Impaired renal potassium excretion can be caused by a primary decrease in distal sodium delivery, a primary decrease in mineralocorticoid level or activity, or abnormal cortical collecting duct function. Excessive potassium intake is an infrequent cause of hyperkalemia by itself, but can worsen the severity of hyperkalemia when renal excretion is impaired. Before concluding that a cell shift or renal defect in potassium excretion is present, pseudohyperkalemia should be excluded.

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