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Toxicology – Hyperkalemia (Elevated Potassium Levels)
Source
Elevated potassium levels can result from potassium supplements, kidney failure (especially in dialysis patients), and certain medications such as ACE inhibitors, NSAIDs, and potassium-sparing diuretics. It may also occur due to cellular breakdown in conditions like rhabdomyolysis, hemolysis, or tumor lysis syndrome.
Typical Presentation
Patients may present with vague symptoms such as weakness or fatigue, but serious cases often involve cardiac abnormalities detected on ECG, especially in those with impaired kidney function.
Clinical Features
Symptoms are often nonspecific and may include:
High extracellular potassium alters the electrical gradient across cardiac cells, making them more excitable and prone to dangerous arrhythmias.
Management
Treatment is urgent and involves three main strategies:
Source
Elevated potassium levels can result from potassium supplements, kidney failure (especially in dialysis patients), and certain medications such as ACE inhibitors, NSAIDs, and potassium-sparing diuretics. It may also occur due to cellular breakdown in conditions like rhabdomyolysis, hemolysis, or tumor lysis syndrome.
Typical Presentation
Patients may present with vague symptoms such as weakness or fatigue, but serious cases often involve cardiac abnormalities detected on ECG, especially in those with impaired kidney function.
Clinical Features
Symptoms are often nonspecific and may include:
- Generalized weakness and malaise
- Slow heart rate (bradycardia)
- Cardiac arrhythmias
- Peaked T waves
- Prolonged PR interval
- Flattened or absent P waves
- Widened QRS complex
- “Sine wave” pattern leading to cardiac arrest
High extracellular potassium alters the electrical gradient across cardiac cells, making them more excitable and prone to dangerous arrhythmias.
Management
Treatment is urgent and involves three main strategies:
- Stabilize the heart
- IV calcium (calcium gluconate or calcium chloride) to protect cardiac membranes
- Shift potassium into cells
- Insulin with glucose
- β-agonists (e.g., high-dose nebulized albuterol)
- Sodium bicarbonate (in cases of acidosis)
- Remove potassium from the body
- Dialysis (most effective in severe cases)
- Potassium-binding resins (e.g., sodium polystyrene sulfonate)
- ECG monitoring is essential in suspected hyperkalemia.
- Calcium does not lower potassium—it stabilizes the heart.
- Severe hyperkalemia is a medical emergency due to risk of fatal arrhythmias.
- Kidney function plays a major role in potassium regulation.
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