How Dangerous Is Hyperkalemia?

Abstract

Hyperkalemia is a potentially life-threatening electrolyte disorder appreciated with greater frequency in patients with renal disease, heart failure, and with use of certain medications such as renin angiotensin aldosterone inhibitors. The traditional views that hyperkalemia can be reliably diagnosed by electrocardiogram and that particular levels of hyperkalemia confer cardiotoxic risk have been challenged by several reports of patients with atypic presentations. Epidemiologic data demonstrate strong associations of morbidity and mortality in patients with hyperkalemia but these associations appear disconnected in certain patient populations and in differing clinical presentations. Physiologic adaptation, structural cardiac disease, medication use, and degree of concurrent illness might predispose certain patients presenting with hyperkalemia to a lower or higher threshold for toxicity. These factors are often overlooked; yet data suggest that the clinical context in which hyperkalemia develops is at least as important as the degree of hyperkalemia is in determining patient outcome. This review summarizes the clinical data linking hyperkalemia with poor outcomes and discusses how the efficacy of certain treatments might depend on the clinical presentation.

Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax

“…She was hyperkalemic (5.5) at presentation. This is also unlikely to be the cause of her acute bradycardia because a more dramatic elevation of potassium (>7.0) is usually required to cause acute bradycardia when there are no other AV blockers in the picture [10–12]. She has no history of right ventricular hypertrophy, rheumatic heart disease, cor pulmonale, pulmonary embolism, or myocarditis.…”

Haste makes waste—Should current guideline recommendations for initiation of renal replacement therapy for acute kidney injury be changed?

“…For example, data demonstrating an association between dismal outcome and hyperkalemia are largely retrospective . In a study by McMahon et al, potassium concentrations at ICU admission and duration of hyperkalemia are strong predictors of all‐cause mortality with a significant risk gradient across serum potassium strata, but this is probably explained by the association of hyperkalemia itself with worse disease conditions.…”

“…In a study by McMahon et al, potassium concentrations at ICU admission and duration of hyperkalemia are strong predictors of all‐cause mortality with a significant risk gradient across serum potassium strata, but this is probably explained by the association of hyperkalemia itself with worse disease conditions. The use of RRT for management of hyperkalemia has not been associated with improved survival, whereas more conservative treatments such as IV calcium or insulin/dextrose are . The underlying explanations are complex ranging from the fact that RRT is indeed inferior, from higher complication rates for RRT wiping out potential benefits, from the perils of a too rapid correction of potassium, from more sick patients receiving RRT (selection bias) or from RRT being the last resort (indication bias).…”

“…For example, data demonstrating an association between dismal outcome and hyperkalemia are largely retrospective. 14…”

“…The use of RRT for management of DOI: 10.1111/sdi.12693 hyperkalemia has not been associated with improved survival, whereas more conservative treatments such as IV calcium or insulin/ dextrose are. 14,16 The underlying explanations are complex ranging from the fact that RRT is indeed inferior, from higher complication rates for RRT wiping out potential benefits, from the perils of a too rapid correction of potassium, from more sick patients receiving RRT…”