Hyperkalemia: Causes, Symptoms, ECG Changes, and Emergency Management for Elevated Blood Potassium Levels

DEFINITION 

 Hyperkalemia is a condition where the potassium level in the blood exceeds 5.0 mmol/L. Potassium is a vital electrolyte that helps regulate muscle function, nerve impulses, and heart rhythm.

Causes: 

Decreased excretion: 

Chronic kidney disease, acute kidney injury, adrenal insufficiency (e.g., Addison’s disease), or medications like ACE inhibitors, ARBs, potassium-sparing diuretics.

Excess intake: 

Overconsumption of potassium supplements or potassium-rich foods.

Cellular shift: 

Conditions like metabolic acidosis, hemolysis, rhabdomyolysis, burns, or tumor lysis syndrome.

Pseudohyperkalemia: 

Hemolysis during blood sample collection.

Symptoms:

Muscle weakness or paralysis.

Fatigue or lethargy.

Paresthesia (tingling sensations).

Nausea.

Cardiac arrhythmias, including bradycardia, ventricular fibrillation, or asystole.

ECG Changes:

Peaked T waves.

Widened QRS complexes.

Flattened or absent P waves.

Sine wave pattern (severe cases).

Management:

1. Stabilize the heart: Administer calcium gluconate to prevent arrhythmias.

2. Shift potassium intracellularly: Use insulin with glucose, beta-2 agonists (e.g., albuterol), or sodium bicarbonate if acidosis is present.

3. Eliminate excess potassium: Diuretics, cation-exchange resins (e.g., sodium polystyrene sulfonate), or dialysis for severe cases.

4. Address underlying causes: Treat contributing conditions and adjust medications.

Management focuses on stabilizing the heart, shifting potassium intracellularly, and removing excess potassium. Calcium gluconate or calcium chloride is used to protect the heart.

Hyperkalemia is a medical emergency when severe, requiring immediate treatment to prevent life-threatening complications.

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