Hyperkalemia in the Elderly

Type IV renal tubular acidosis and spironolactone therapy in the elderly

“…It can be found in primary aldosterone deficiency due to Addison's disease, but also occurs as a direct consequence of spironolactone therapy which competitively blocks the action of aldosterone on the distal tubule, and in association with renal insufficiency and volume contraction.4 It may also arise because of disease of the juxtaglomerular apparatus which causes impaired production of renin and secondary hypoaldosteronism, a condition known as hyporeninaemic hypoaldosteronism.3 This is common in the elderly, and has been described in association with diabetes mellitus, hypertension,5 urinary tract obstruction,6 and drugs which inhibit the renin-angiotensin system such as beta-blockers and prostaglandin synthetase inhibitors. 2 We believe that our patient had mild underlying hyporeninaemic hypoaldosteronism and that she developed severe hyperkalaemia as a result of the addition of spironolactone. Spironolactone has a duration of action of up to 5 days which might explain why our patient's metabolic derangement was initially resistant to conventional therapy.…”

“…It is well known that the latter should be avoided in renal failure, but the risk of significant hyperkalaemia in elderly subjects with mild renal impairment is less well recognized. 2 We describe the case of an 88 year old woman who developed life-threatening hyperkalaemia with distal renal tubular acidosis (type IV) while on treatment with spironolactone.…”

Hyperkalaemic quadriparesis secondary to chronic diclofenac treatment

“…Non-steroidal anti-inflammatory drugs can cause hyperkalaemia by producing a syndrome of hyporeninaemic hypoaldosteronism (hyperkalaemia and metabolic acidosis)1 2 and inhibiting renin release 3…”

Electrolyte Disorders in Cancer Patients

“…A host of medications known to decrease aldosterone secretion or effect, and which can therefore cause hyperkalemia, includes heparin, cyclosporine, NSAIDs, spironolactone, trimethoprim, amiloride, ACE inhibitors, and angiotension receptor blockers [112][113][114][115][116].…”