Etiology : Pseudohyperkalemia (In Vitro Release of Potassium From Cells)

Etiology : Excessive Potassium Intake

Etiology : Intracellular -> Extracellular Potassium Shift

Etiology : Impaired Renal Potassium Excretion

Decreased Distal Potassium Delivery

Renal Disease

Hypoaldosteronism (see Hypoaldosteronism)

Decreased Aldosterone Synthesis

Aldosterone Resistance


Transtubular Potassium Gradient

Urine Potassium/Sodium Ratio

Clinical Manifestations

Cardiovascular Manifestations

Atrioventricular Heart Blocks

Sinus Bradycardia (see Sinus Bradycardia)

  • Epidemiology
    • May Occur in Some Cases

Cardiac Arrest (see Cardiac Arrest)

  • Epidemiology
    • May Occur in the Setting of Acute/Severe Hyperkalemia

Electrocardiographic (EKG) Changes

  • Clinical
    • Tall, Peaked T-Waves with Shortened QTc Interval (see xxxx): initial change which is usually noted
    • Widened PR Interval and Widened QRS Duration: seen later
    • Disappearance of P-Wave: may occur
    • QRS Widened to a Sine Wave Pattern: typically a late EKG finding
    • Ventricular Standstill (with Complete Absence of Electrical Activity)/Asystole: latest change

Gastrointestinal Manifestations

Hypoactive Bowel Sounds/Ileus (see Ileus)

  • Epidemiology
    • XXXX

Neurologic Manifestations

Depression (see Depression)

  • Epidemiology
    • XXXX

Fatigue (see Fatigue)

  • Epidemiology
    • XXXX

Hyporeflexia (see Hyporeflexia)

  • Epidemiology
    • XXXX

Muscle Weakness/Flaccid Paralysis (J Neurol Neurosurg Psychiatry, 1998) [MEDLINE]

  • Clinical
    • May Be Severe Enough to Mimic the Symptoms of Guillain-Barré Syndrome
    • Cranial Nerve Function and Sphincter Tone Function are Generally Intact
    • Respiratory Muscle Weakness is Rare

Pulmonary Manifestations

Acute/Chronic Hypoxemic/Hypercapnic Respiratory Failure (see Respiratory Failure)

  • Epidemiology
    • Respiratory Muscle Weakness is Rare (Br J Anaesth, 1993) [MEDLINE]
  • Physiology
    • Due to Respiratory Muscle Weakness

Renal Manifestations

Metabolic Acidosis (in the Setting of Type 4 Renal Tubular Acidosis) (see Metabolic Acidosis-Normal Anion Gap)

  • Epidemiology
    • In Type 4 Renal Tubular Acidosis in Animal Models, Hyperkalemia Decreases Proximal Tubule Ammonia Generation and Collecting Duct Ammonia Transport, Leading to Impaired Ammonia Excretion Which Causes Metabolic Acidosis (J Am Soc Nephrol, 2018) [MEDLINE]


Insulin (see Insulin)


Sodium Bicarbonate (see Sodium Bicarbonate)

Hypertonic (3%) Saline (see Hypertonic Saline)

Kayexelate (Sodium Polystyrene) (see Kayexelate)

Patiromer (Veltassa) (see Patiromer)

Sodium Zirconium Cyclosilicate (Lokelma) (see Sodium Zirconium Cyclosilicate)

Albuterol (see Albuterol)

Management of Hyperkalemia in Cardiorenal Patients on Renin–Angiotensin–Aldosterone System Inhibitors

Recommendations of International Delphi Consensus for Management of Hyperkalemia in Patients with Cardiorenal Syndrome (Eur J Heart Fail, 2022) [MEDLINE]