Hyperkalemia causes

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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]; Raviteja Guddeti, M.B.B.S. [3], Mahmoud Sakr, M.D. [4]


Hyperkalemia is an elevated blood level (above 5.1 mmol/L) of the electrolyte potassium. ". Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias.


Life Threatening Causes

Common Causes

The most common causes of hyperkalemia include:[2][3]

Less common causes

  • Fasting
  • Exercise
  • Fluoride toxicity
  • Hypoparathyroidism

Genetic causes

  • Congenital adrenal hypoplasia
  • Hyperkalemic periodic paralysis
  • Pseudohypoaldosteronism type1 and type 2

Causes by Organ System

Cardiovascular Heart failure, volume depletion
Chemical / poisoning Ammonium Bifluoride, arsenicals, fluoride toxicity, foxglove poisoning, oleander poisoning, tungsten, white chameleon poisoning
Dermatologic No underlying causes
Drug Side Effect ACE inhibitors, Acetaminophen and Oxycodone, acetylsalicylic Acid, aldosterone antagonists, amiloride, Amlodipine besylate and Valsartan, angiotensin receptor blockers, Basiliximab, beta blockers, Cefepime, Cefpodoxime, celecoxib, Cidofovir, cyclosporine, diazoxide, digoxin, Drospirenone and Ethinyl estradiol, eplerenone, epsilon amino caproic acid, (EACA), erythropoietin, heparin, ibuprofen, indomethacin, isoflurane, ketoprofen, low-molecular weight heparin, Lisinopril and Hydrochlorothiazide, mannitol, melarsoprol, methotrexate, minoxidil, naproxen, Nivolumab, Nilotinib, pancuronium bromide, pimecrolimus, potassium chloride, Potassium bicarbonate, potassium citrate, pomalidomide,propofol infusion syndrome, rifaximin, sodium thiopental, somatostatin therapy, spironolactone, succinylcholine, sulindac, suxamethonium, tacrolimus, thalidomide, triamterene, trimethoprim
Ear Nose Throat No underlying causes
Endocrine ACTH Deficiency, addisonian crisis, addison's disease, adrenal gland disorders, adrenal hyperplasia, congenital type 3, autoimmune adrenalitis, congenital adrenal hyperplasia -- sodium-wasting form, diabetes, diabetic ketoacidosis, hyperglycemia, hypoadrenocorticism -- hypoparathyroidism -- moniliasis, hyporeninemic hypoaldosteronism, isolated aldosterone synthase deficiency, lipoid congenital adrenal hyperplasia, pseudohypoaldosteronism type 1, pseudohypoaldosteronism type 2
Environmental No underlying causes
Gastroenterologic Cirrhosis, gastrointestinal bleeding
Genetic 18-Hydroxylase deficiency, congenital adrenal hyperplasia type 3, congenital adrenal hyperplasia -- sodium-wasting form, isolated aldosterone synthase deficiency, lipoid congenital adrenal hyperplasia, pseudohypoaldosteronism type 1, pseudohypoaldosteronism type 2
Hematologic Hemolytic anemia, leukaemia, leukocytosis, sickle cell disease, thrombotic thrombocytopenic purpura
Iatrogenic blood transfusion , cuffed blood sample, delayed separation blood sample, drip arm sample, EDTA blood sample, hemolysed blood sample, IV fluids containing potassium, using clenched fist while collection of blood
Infectious Disease HIV infection
Musculoskeletal / Ortho Muscle damage, muscle wasting
Neurologic Amelo-cerebro-hypohidrotic syndrome, Kohlschutter-Tonz syndrome
Nutritional / Metabolic hydrochloride Arginine, high Potassium diet, Malnutrition
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte Acidosis, acute glomerulonephritis, acute renal failure, chronic interstitial nephritis, chronic renal failure, diabetic nephropathy, distal chloride shunt, distal renal tubular acidosis type IV, Gordon's syndrome, hemolytic uremic syndrome, hyperkalemic periodic paralysis, hyperkalemic Renal tubular acidosis, hypernatremia, hyperosmolality, hyperphosphataemia, lupus nephritis, obstructive uropathy, polycystic kidney disease, Familial pseudohyperkalemia-due to red cell leak, Distal renal tubular acidosis type 1, transplanted kidneys, tubulointerstitial disease, urinary tract obstruction, urolithiasis, hyporeninemic hypoaldosteronism, amyloidosis
Rheum / Immune / Allergy systemic lupus erythematosus, autoimmune adrenalitis
Sexual No underlying causes
Trauma crush syndrome
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Amyloidosis - Renal, burns, dehydration, fasting, hypothermia, internal bleeding, intravenous infusion, malignant hyperpyrexia, phlebotomy complication, rhabdomyolysis, sea snake poisoning, selective impairment of potassium excretion, strenuous exercise, transplant rejection, tumor lysis syndrome, ureterojejunostomy

Causes in Alphabetical Order


  1. De Nicola L, Bellizzi V, Minutolo R, Cioffi M, Giannattasio P, Terracciano V; et al. (2000). "Effect of dialysate sodium concentration on interdialytic increase of potassium". J Am Soc Nephrol. 11 (12): 2337–43. PMID 11095656.
  2. Wang WH, Giebisch G (2009). "Regulation of potassium (K) handling in the renal collecting duct". Pflugers Arch. 458 (1): 157–68. doi:10.1007/s00424-008-0593-3. PMC 2730119. PMID 18839206.
  3. Giebisch GH, Wang WH (2010). "Potassium transport--an update". J Nephrol. 23 Suppl 16: S97–104. PMID 21170894.
  4. Sevastos N et al. (2006) Pseudohyperkalemia in serum: the phenomenon and its clinical magnitude. J Lab Clin Med, 147(3):139-44; PMID 16503244.
  5. Don BR et al. (1990) Pseudohyperkalemia caused by fist clenching during phlebotomy. N Engl J Med, 322(18):1290-2; PMID 2325722.
  6. Iolascon A et al. (1999) Familial pseudohyperkalemia maps to the same locus as dehydrated hereditary stomatocytosis. Blood, 93(9):3120-3; PMID 10216110.