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Symptoms and Signs – Differential Diagnosis of Hyperkalemia
PSEUDOHYPERKALEMIA
• Hemolyzed specimen
• Severe thrombocytosis (platelet count >106 mL)
• Severe leukocytosis (white blood cell count >105 mL)
• Fist clenching during phlebotomy
EXCESSIVE POTASSIUM INTAKE (OFTEN IN SETTING OF
IMPAIRED EXCRETION)
• Potassium replacement therapy
• High-potassium diet
• Salt substitutes with potassium
• Potassium salts of antibiotics
DECREASED RENAL EXCRETION
• Potassium-sparing diuretics (e.g., spironolactone, triamterene,
amiloride)
• Renal insufficiency
• Mineralocorticoid deficiency
• Hyporeninemic hypoaldosteronism (diabetes mellitus [DM])
• Tubular unresponsiveness to aldosterone (e.g., systemic lupus
erythematosus [SLE], multiple myeloma, sickle cell disease)
• Type 4 renal tubular acidosis (RTA)
• Angiotensin-converting enzyme (ACE) inhibitors
• Heparin administration
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Trimethoprim-sulfamethoxazole
• β-Blockers
• Pentamidine
REDISTRIBUTION (EXCESSIVE CELLULAR RELEASE)
• Acidemia (each 0.1 decrease in pH increases the serum potassium
by 0.4 to 0.6 mEq/L). Lactic acidosis and ketoacidosis cause
minimal redistribution.
• Insulin deficiency
• Drugs (e.g., succinylcholine, markedly increased digitalis level,
arginine, β-adrenergic blockers)
• Hypertonicity
• Hemolysis
• Tissue necrosis, rhabdomyolysis, burns
PSEUDOHYPERKALEMIA
• Hemolyzed specimen
• Severe thrombocytosis (platelet count >106 mL)
• Severe leukocytosis (white blood cell count >105 mL)
• Fist clenching during phlebotomy
EXCESSIVE POTASSIUM INTAKE (OFTEN IN SETTING OF
IMPAIRED EXCRETION)
• Potassium replacement therapy
• High-potassium diet
• Salt substitutes with potassium
• Potassium salts of antibiotics
DECREASED RENAL EXCRETION
• Potassium-sparing diuretics (e.g., spironolactone, triamterene,
amiloride)
• Renal insufficiency
• Mineralocorticoid deficiency
• Hyporeninemic hypoaldosteronism (diabetes mellitus [DM])
• Tubular unresponsiveness to aldosterone (e.g., systemic lupus
erythematosus [SLE], multiple myeloma, sickle cell disease)
• Type 4 renal tubular acidosis (RTA)
• Angiotensin-converting enzyme (ACE) inhibitors
• Heparin administration
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Trimethoprim-sulfamethoxazole
• β-Blockers
• Pentamidine
REDISTRIBUTION (EXCESSIVE CELLULAR RELEASE)
• Acidemia (each 0.1 decrease in pH increases the serum potassium
by 0.4 to 0.6 mEq/L). Lactic acidosis and ketoacidosis cause
minimal redistribution.
• Insulin deficiency
• Drugs (e.g., succinylcholine, markedly increased digitalis level,
arginine, β-adrenergic blockers)
• Hypertonicity
• Hemolysis
• Tissue necrosis, rhabdomyolysis, burns
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