dhyperkaliémie

Hyperkalemia, sometimes written in French as d'hyperkaliémie, is a condition characterized by elevated potassium levels in the blood. A serum potassium above about 5.0 mmol/L is considered hyperkalemia, with higher levels indicating greater severity (mild 5.1–5.9, moderate 6.0–6.4, severe ≥6.5). Potassium balance depends on renal excretion, hormonal control, and shifts between intracellular and extracellular compartments.

Causes include reduced renal excretion (chronic kidney disease, hypoaldosteronism, advanced kidney failure) and medications that raise potassium levels (ACE inhibitors, ARBs, potassium-sparing diuretics, NSAIDs). Other factors involve redistribution or release from cells: acidosis, insulin deficiency, tissue breakdown (rhabdomyolysis, tumor lysis). Excessive potassium intake in susceptible individuals can contribute. Pseudohyperkalemia from hemolysis or specimen error can mimic true hyperkalemia.

Clinical features vary; many cases are asymptomatic. Key concerns are cardiac effects: electrocardiogram changes such as tall peaked T waves, prolonged PR interval, widened QRS, and at high levels a sine wave pattern or cardiac arrest. Diagnosis relies on a confirmed serum potassium measurement, repeat testing if needed, ECG assessment, and evaluation for underlying causes and coexisting abnormalities (kidney function, acid-base status).

Management aims to stabilize the heart, shift potassium into cells, and remove excess potassium from the body. If there are ECG changes or very high potassium, administer calcium to stabilize the myocardium; then shift potassium intracellularly with insulin and glucose, with or without beta-agonists or bicarbonate if indicated. To remove potassium, use diuretics, potassium binders (older sodium polystyrene sulfonate; newer agents such as patiromer or sodium zirconium cyclosilicate), or dialysis in renal failure. Address offending medications and correct underlying causes. Prevention involves dietary potassium management and regular monitoring in at-risk patients.