Hyperkalemia laboratory findings: Difference between revisions
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| [[ | | [[Image:Siren.gif|link=hyperkalemia resident survival guide|41x41px]]|| <br> || <br> | ||
| [[Hyperkalemia resident survival guide|Resident <br> Survival <br> Guide]] | | [[Hyperkalemia resident survival guide|Resident <br> Survival <br> Guide]] | ||
|} | |} | ||
{{Hyperkalemia}} | {{Hyperkalemia}} | ||
{{CMG}}; | {{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], {{ADG}} | ||
==Overview== | ==Overview== | ||
In a patient who does not have a risk for hyperkalemia, repeating the blood test is indicated before taking any actions unless changes are present on electrocardiography. | In a patient who does not have a risk for hyperkalemia, repeating the blood test is indicated before taking any actions unless changes are present on [[electrocardiography]] | ||
==Laboratory Findings== | |||
*The first step in diagnosing hyperkalemia is to exclude [[pseudohyperkalemia]] by repeating the blood test.<ref name="pmid21181208">{{cite journal| author=Lehnhardt A, Kemper MJ| title=Pathogenesis, diagnosis and management of hyperkalemia. | journal=Pediatr Nephrol | year= 2011 | volume= 26 | issue= 3 | pages= 377-84 | pmid=21181208 | doi=10.1007/s00467-010-1699-3 | pmc=3061004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21181208 }}</ref> | |||
{| class="wikitable" | {| class="wikitable" | ||
!Grade | !Grade | ||
| Line 17: | Line 17: | ||
|- | |- | ||
|Mild | |Mild | ||
|5- | |5-6.0mEq/L | ||
|- | |- | ||
|Moderate | |Moderate | ||
|7 | |6.1-7.2mEq/L | ||
|- | |- | ||
|Severe | |Severe | ||
|> | |>7.2mEq/L | ||
|} | |} | ||
===Initial tests=== | ===Initial tests=== | ||
*Complete blood count (CBC) | *Complete blood count (CBC)<ref name="pmid25415806">{{cite journal| author=Ingelfinger JR| title=A new era for the treatment of hyperkalemia? | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 3 | pages= 275-7 | pmid=25415806 | doi=10.1056/NEJMe1414112 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25415806 }}</ref> | ||
*Metabolic profile | *Metabolic profile .<ref name="pmid27939860">{{cite journal |vauthors=Kogika MM, de Morais HA |title=A Quick Reference on Hyperkalemia |journal=Vet. Clin. North Am. Small Anim. Pract. |volume=47 |issue=2 |pages=223–228 |year=2017 |pmid=27939860 |doi=10.1016/j.cvsm.2016.10.009 |url=}}</ref> | ||
*Urine potassium, sodium, and osmolality | *Urine potassium, sodium, and [[Osmolarity|osmolality]] <ref name="pmid2402122">{{cite journal| author=Conte G, Dal Canton A, Imperatore P, De Nicola L, Gigliotti G, Pisanti N et al.| title=Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure. | journal=Kidney Int | year= 1990 | volume= 38 | issue= 2 | pages= 301-7 | pmid=2402122 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2402122 }} </ref> | ||
*Aldosterone | |||
*[[Aldosterone]] | |||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | A01 | | | | | | | | | | | | | | | | |A01=Hyperkalemia}} | {{familytree | | | | | | | A01 | | | | | | | | | | | | | | | | |A01=Hyperkalemia}} | ||
{{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | |B01=Exclude psuedohyperkalemia by repeating the blood test }} | {{familytree | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | |B01=Exclude [[psuedohyperkalemia]] by repeating the blood test }} | ||
{{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | }} | ||
{{familytree | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | | | | }} | {{familytree | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | | | | }} | ||
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{{familytree | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }} | {{familytree | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }} | ||
{{familytree | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }} | {{familytree | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }} | ||
{{familytree | D01 | | | | | | | | | | D02 | | | | | | | | |D01=Increase release of K+ from cells<br> Trauma,radiation therapy, DKA, metabolic acidosis|D02= Decreased urinary excreation of K+<br> rule out aldosterone deficency<br> 24 hr urine K+ excreation}} | {{familytree | D01 | | | | | | | | | | D02 | | | | | | | | |D01=Increase release of K+ from cells<br> Trauma,radiation therapy, [[DKA]], [[metabolic acidosis]]|D02= Decreased urinary excreation of K+<br> rule out [[aldosterone]] deficency<br> 24 hr urine K+ excreation}} | ||
{{familytree/end}} | {{familytree/end}} | ||
<small> </small> | <small> </small> | ||
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===Cause specific=== | ===Cause specific=== | ||
*Blood glucose In patients with history of diabetes mellitus | *Blood glucose In patients with history of diabetes mellitus | ||
*Digoxin level | *[[Digoxin]] level | ||
*Arterial or venous blood gas (acidosis) | *Arterial or venous blood gas ([[acidosis]]) | ||
*Urinalysis (renal insufficiency) | *Urinalysis (renal insufficiency) | ||
*Serum cortisol and aldosterone levels (mineralocorticoid deficiency) | *Serum [[cortisol]] and [[aldosterone]] levels ([[mineralocorticoid]] deficiency) | ||
*Serum uric acid and phosphorus assays (tumor lysis syndrome) | *Serum uric acid and phosphorus assays (tumor lysis syndrome) | ||
*Serum creatinine phosphokinase (CPK) and calcium measurements and urine myoglobin test (crush injury or rhabdomyolysis) | *Serum [[Creatine kinase|creatinine phosphokinase]] (CPK) and calcium measurements and urine [[myoglobin]] test (crush injury or rhabdomyolysis) | ||
===Psudeohyperkalemia=== | ===Psudeohyperkalemia=== | ||
*Defined as the release of potassium from cells after their breakdown. Most commonly seen during blood collection, so it's required to repeat blood test in patients with a transient rise in potassium without any risk factors. | *Defined as the release of potassium from cells after their breakdown. Most commonly seen during blood collection, so it's required to repeat blood test in patients with a transient rise in potassium without any risk factors. | ||
*Other causes include | *Other causes include | ||
**Clotting increases release of potassium from platelets | **[[Coagulation|Clotting]] increases release of potassium from [[Platelet|platelets]] | ||
**In patients with history of | **In patients with the history of leukemia where the WBC count is >120,000/microL the potassium is raised to cell fragility | ||
**Hereditary (familial) forms of pseudohyperkalemia | **Hereditary (familial) forms of [[pseudohyperkalemia]] | ||
==References== | ==References== | ||
Latest revision as of 19:38, 30 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2], Aditya Ganti M.B.B.S. [3]
Overview
In a patient who does not have a risk for hyperkalemia, repeating the blood test is indicated before taking any actions unless changes are present on electrocardiography
Laboratory Findings
- The first step in diagnosing hyperkalemia is to exclude pseudohyperkalemia by repeating the blood test.[1]
| Grade | Potassium level |
|---|---|
| Mild | 5-6.0mEq/L |
| Moderate | 6.1-7.2mEq/L |
| Severe | >7.2mEq/L |
Initial tests
- Complete blood count (CBC)[2]
- Metabolic profile .[3]
- Urine potassium, sodium, and osmolality [4]
| Hyperkalemia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Exclude psuedohyperkalemia by repeating the blood test | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute rise in potassium | Persistent hyperkalemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Increase release of K+ from cells Trauma,radiation therapy, DKA, metabolic acidosis | Decreased urinary excreation of K+ rule out aldosterone deficency 24 hr urine K+ excreation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cause specific
- Blood glucose In patients with history of diabetes mellitus
- Digoxin level
- Arterial or venous blood gas (acidosis)
- Urinalysis (renal insufficiency)
- Serum cortisol and aldosterone levels (mineralocorticoid deficiency)
- Serum uric acid and phosphorus assays (tumor lysis syndrome)
- Serum creatinine phosphokinase (CPK) and calcium measurements and urine myoglobin test (crush injury or rhabdomyolysis)
Psudeohyperkalemia
- Defined as the release of potassium from cells after their breakdown. Most commonly seen during blood collection, so it's required to repeat blood test in patients with a transient rise in potassium without any risk factors.
- Other causes include
- Clotting increases release of potassium from platelets
- In patients with the history of leukemia where the WBC count is >120,000/microL the potassium is raised to cell fragility
- Hereditary (familial) forms of pseudohyperkalemia
References
- ↑ Lehnhardt A, Kemper MJ (2011). "Pathogenesis, diagnosis and management of hyperkalemia". Pediatr Nephrol. 26 (3): 377–84. doi:10.1007/s00467-010-1699-3. PMC 3061004. PMID 21181208.
- ↑ Ingelfinger JR (2015). "A new era for the treatment of hyperkalemia?". N Engl J Med. 372 (3): 275–7. doi:10.1056/NEJMe1414112. PMID 25415806.
- ↑ Kogika MM, de Morais HA (2017). "A Quick Reference on Hyperkalemia". Vet. Clin. North Am. Small Anim. Pract. 47 (2): 223–228. doi:10.1016/j.cvsm.2016.10.009. PMID 27939860.
- ↑ Conte G, Dal Canton A, Imperatore P, De Nicola L, Gigliotti G, Pisanti N; et al. (1990). "Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure". Kidney Int. 38 (2): 301–7. PMID 2402122.