Hyperkalciemi

Hyperkalciemi, also referred to as hyperkalemia, is a medical condition characterized by an elevated potassium level in the blood. In adults, normal serum potassium typically ranges from about 3.5 to 5.0 mmol/L. Hyperkalceimia is usually defined as a value above 5.0 mmol/L, with higher levels increasing the risk of cardiac conduction abnormalities and arrest.

Causes of hyperkalciemi include reduced renal potassium excretion (such as in chronic kidney disease or acute kidney injury, and hypoaldosteronism), medications that raise potassium (ACE inhibitors, ARBs, potassium-sparing diuretics like spironolactone, amiloride, or triamterene), and nonsteroidal anti-inflammatory drugs. Other factors include tissue breakdown (rhabdomyolysis, tumor lysis syndrome), shifts of potassium out of cells due to acidosis or insulin deficiency, and, less commonly, excessive dietary potassium intake in the setting of impaired clearance.

Clinical features vary; many patients are asymptomatic. When present, symptoms may include muscle weakness, fatigue, or paresthesias. Electrocardiographic changes are important indicators and can progress from tall peaked T waves and PR prolongation to QRS widening and, in severe cases, a sine wave pattern. Hyperkalciemi can lead to life-threatening arrhythmias.

Diagnosis relies on serum potassium measurement, with attention to sample quality (hemolysis can artifactually elevate potassium). Evaluation typically includes renal function, acid–base status, and review of medications, plus ECG monitoring when potassium is elevated.

Management aims to protect the heart, shift potassium intracellularly, and remove excess potassium from the body. Urgent stabilization with IV calcium, followed by insulin with glucose, albuterol, or bicarbonate as indicated, is common. Potassium removal methods include loop diuretics, potassium binders (sodium polystyrene sulfonate, patiromer, or sodium zirconium cyclosilicate), and dialysis in severe or refractory cases. Long-term management focuses on treating underlying conditions, adjusting medications, and restricting dietary potassium as needed.