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Pathogenesis, diagnosis and management of hyperkalemia


Hyperkalemia is a potentially life-threatening condition in which serum potassium exceeds 5.5 mmol/l. It can be caused by reduced renal excretion, excessive intake or leakage of potassium from the intracellular space. In addition to acute and chronic renal failure, hypoaldosteronism, and massive tissue breakdown as in rhabdomyolysis, are typical conditions leading to hyperkalemia. Symptoms are non-specific and predominantly related to muscular or cardiac dysfunction. Treatment has to be initiated immediately using different therapeutic strategies to increase potassium shift into the intracellular space or to increase elimination, together with reduction of intake. Knowledge of the physiological mechanisms of potassium handling is essential in understanding the causes of hyperkalemia as well as its treatment. This article reviews the pathomechanisms leading to hyperkalemic states, its symptoms, and different treatment options.

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Author information

Correspondence to Markus J. Kemper.

Additional information


1. e

2. a

3. (a) true (b) false (c) true (d) false (e) true

4. (a) false (b) true (c) false (d) true (e) true

5. d

6. b

Multiple-choice questions

Multiple-choice questions

(Answers appear following the reference list)

  1. 1)

    Which is the most important site of K+ secretion in the kidney?

    1. a)

      proximal tubule

    2. b)

      thin descending limb of loop of Henle

    3. c)

      thick ascending limb of loop of Henle

    4. d)

      distal tubule convolute

    5. e)

      cortical collecting duct

  1. 2)

    Which drug does not cause hyperkalemia?

    1. a)


    2. b)


    3. c)


    4. d)


    5. e)


  1. 3)

    Which of the following clinical conditions typically causes hyperkalemia (answer true or false for (a) through (e))

    1. a)

      acute renal failure

    2. b)

      acute myocardial infarction

    3. c)


    4. d)


    5. e)

      Gordon’s syndrome

  1. 4)

    In managing a patient with severe hyperkalemia: (answer true or false for (a) through (e))

    1. a)

      first aspect of management is to establish the underlying diagnosis

    2. b)

      ECG may show QRS widening

    3. c)

      the patient is invariably vomiting

    4. d)

      in the short term, calcium gluconate may reduce risk of arrhythmias

    5. e)

      ventricular fibrillation and death may occur

  1. 5)

    The mode of action of salbutamol and glucose/insulin is mediated by

    1. a)

      an increase of renal elimination of potassium

    2. b)

      a reduction of intestinal potassium intake

    3. c)

      stabilization of membrane potential

    4. d)

      an increase of potassium shift from extracellular into intracellular compartment

    5. e)


  1. 6)

    In anuric patients, treatment of hyperkalemia

    1. a)

      should include diuretics

    2. b)

      by increasing elimination of potassium via the gut (e.g., by enemas) may be an important option

    3. c)

      is an infrequent problem

    4. d)

      is always associated with cardiac symptoms

    5. e)

      by shifting potassium into the intracellular department is ineffective

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Lehnhardt, A., Kemper, M.J. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol 26, 377–384 (2011). https://doi.org/10.1007/s00467-010-1699-3

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  • Hyperkalemia
  • Potassium
  • Renal failure
  • Salbutamol