iperkaliemia

Iperekaliemia, or hyperkalemia, is a condition defined by elevated potassium in the blood. A serum potassium level above 5.0 mmol/L is generally considered abnormal, with higher values carrying greater risk for cardiac and neuromuscular complications. The onset can be rapid or gradual, and severity depends on the rate of rise and accompanying conditions.

Causes fall into three categories: reduced renal potassium excretion (for example in chronic kidney disease or acute kidney injury, and with hypoaldosteronism); redistribution of potassium from cells into the extracellular space (such as acidosis, tissue injury, insulin deficiency, or certain medications); and increased intake or artifactual elevation (pseudohyperkalemia from sample handling). Medications commonly implicated include ACE inhibitors, ARBs, potassium-sparing diuretics, and certain antibiotics.

Potassium is mainly an intracellular ion; when extracellular potassium rises, resting membrane potential changes and cardiac conduction can be affected, leading to arrhythmias. Kidney dysfunction reduces potassium elimination. These mechanisms explain the clinical risk associated with hyperkalemia, especially in patients with heart or kidney disease.

Clinical presentation ranges from none to weakness, paresthesias, and life-threatening arrhythmias. Diagnosis relies on confirming elevated serum potassium and evaluating ECG changes, kidney function, acid–base status, and potential contributing causes.

Treatment is guided by potassium level and ECG findings. In suspected or manifest hyperkalemia with ECG changes, urgent therapy includes stabilizing the heart with calcium and reducing potassium by shifting it into cells (insulin with glucose, beta-agonists, bicarbonate if acidosis). Methods to remove potassium from the body include diuretics, cation-exchange resins, or dialysis in severe cases. Long-term management focuses on removing triggers, adjusting medications, and monitoring potassium levels.