Hyperkalemia laboratory findings

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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

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

  1. 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.
  2. 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.
  3. 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.
  4. 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.



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