Hyperkalemia
Hyperkalemia, also spelled hyperkalaemia, is an elevated level of potassium (K+) in the blood serum.[1] Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5 mmol/L defined as hyperkalemia.[3][4] Typically this results in no symptoms.[1] Occasionally when severe it results in palpitations, muscle pain, muscle weakness, or numbness.[1][2] An abnormal heart rate can occur which can result in cardiac arrest and death.[1][3] Common causes include kidney failure, hypoaldosteronism, and rhabdomyolysis.[1] A number of medications can also cause high blood potassium including spironolactone, NSAIDs, and angiotensin converting enzyme inhibitors.[1] The severity is divided into mild (5.5-5.9 mmol/L), moderate (6.0-6.4 mmol/L), and severe (>6.5 mmol/L).[3] High levels can also be detected on an electrocardiogram (ECG).[3] Pseudohyperkalemia, due to breakdown of cells during or after taking the blood sample, should be ruled out.[1][2] Initial treatment in those with ECG changes is calcium gluconate.[1][3] Medications that might worsen the condition should be stopped and a low potassium diet should be recommended.[1] Other medications used include dextrose with insulin, salbutamol, and sodium bicarbonate.[1][5] Measures to remove potassium from the body include furosemide, polystyrene sulfonate, and hemodialysis.[1] Hemodialysis is the most effective method.[3] The use of polystyrene sulfonate, while common, is poorly supported by evidence.[6] Hyperkalemia is rare among those who are otherwise healthy.[7] Among those who are in hospital, rates are between 1% and 2.5%.[2] It increases the overall risk of death by at least ten times.[2][7] The word "hyperkalemia" is from hyper- meaning high; kalium meaning potassium; and -emia, meaning "in th Continue reading >>
Potassium Homeostasis
Potassium: a critical cation Potassium (K+) is a main cation essential for many cellular functions. It is the most abundant cation in the body, with 98% in intracellular fluid and only 2% in extracellular fluid. Because of this delicate balance, even the slightest acute compartmental shifts can be fatal.1-3 The pathophysiology of serum potassium homeostasis Regulation of serum potassium is complex and involves appropriate distribution between intracellular and extracellular compartments, and a balance between dietary and supplemental intake and bodily excretion.3,4 (See a list of potassium-rich foods.) The kidney is central to this process, which also relies on several other regulators.4 In healthy individuals, homeostasis is maintained when cellular uptake and urinary or renal excretion naturally counterbalance a patient's dietary intake of K+.4 While values vary from person to person and day to day, the standard normal range of serum potassium is considered to be 3.5 mEq/L to 5.0 mEq/L.5,6 In healthy individuals, 90% of K+ is absorbed through the gut into the serum where the majority is taken up by cells. There is a delicate balance between intracellular and extracellular levels, with nearly 98% of K+ found in the intracellular compartment.7 The ratio of intracellular to extracellular K+, managed primarily by sodium-potassium ATPase, is important in determining the cell membrane potential.7 Other ion channels and transporters can also play a role in affecting this distribution.7 About 70% of the total intracellular content is distributed primarily in the muscles, with smaller amounts present in bone, red blood cells, liver, and skin.3 The kidney plays a major role in the maintenance of K+ balance by adjusting secretion in response to dietary intake, regulating about 9 Continue reading >>
Hypokalaemia And Metabolic Acidosis
Home | Education | Hypokalaemia and Metabolic Acidosis 35 year old Aboriginal female presents with a 2/52 Hx of weakness, thirst and nausea. Presents to ED unable to lift her hands. Admitted 3/12 ago with something similar but doesnt know what it was and her medical notes are not immediately available. No other past medical history of note. Examination reveals a quiet, dehydrated lady with generalised non-lateralising weakness in all 4 limbs. Bedside venous blood gas results included: Sinus rhythm with sinus arrhythmia at a rate of 72 bpm. U waves noted most prominently in leads V1-V3 Sinus arrhythmia [sinus rhythm with slight variation (>0.16 seconds) in the sinus cycles] Normal anion gap metabolic acidosis. The 2 most common causes in ED Other causes are many and varied. There are several mnemonics out there the most recent edition of Rosen suggests: F-USED CARS Basically (and rather obviously), a metabolic acidosis is caused by either excess acid or a loss of alkali. Excess acid may be produced by the body itself or may be exogenous. Calculating the anion gap is used in the context of having made a diagnosis of a metabolic acidosis to help determine possible causes. Its an artificial but pragmatic concept based on the fact that with normal physiology there will be more unmeasured anions (predominantly Albumin, Phosphate and Sulphate) than cations on routine blood testing. Most people dont use potassium in the equation resulting in a normal range of 8-12. (12-16 if potassium included), although in this case it wouldnt have made much difference! A wide anion gap in the setting of a metabolic acidosis (or High Anion Gap Metabolic Acidosis [HAGMA]) suggests there is excess unmeasured anion / acid. Keeping it simple, there are only 4 causes: Essentially a state of excess Continue reading >>
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- Ultraviolet Radiation Suppresses Obesity and Symptoms of Metabolic Syndrome Independently of Vitamin D in Mice Fed a High-Fat Diet
- Why Diabetes Is Dangerous: How to Recognize the Signs of this Metabolic Disease
Renal Tubular Acidosis & Potassium Disorders 10-3
Understand the role of the proximal tubule in bicarbonate reabsorption. The majority of bicarbonate reclamation occurs in the proximal tubule through the Na+/H+ exchanger Understand how the kidneys excrete hydrogen ions through ammoniagenesis. Active transporters in the distal tubule secrete hydrogen ion against a concentration gradient. Also, NH3 is generated in the proximal tubule by the deamidation of glutamine to glutamate, which is subsequently deaminated to yield NH3 and -ketoglutarate. The enzymes responsible for these reactions are up-regulated by acidosis and hypokalemia. NH3 builds up in the renal interstitium and passively diffuses into the tubule lumen along the length of the collecting duct, where it is trapped by H+ and excreted as NH4. Understand the clinical utility of urine anion gap. It is an estimate of NH4+ excretion, which accounts for the majority of acid excretion. -if Cl- is the anion balancing the charge of NH4+, the gap is negative b/c the chloride is greater than the sum of Na+ & K+ (which are also large components of urine) Understand the collecting tubule mechanism and stimuli for hydrogen ion and potassium secretion. Aldosterone directly increases the activity of the Na+-K+-ATPase in the collecting duct cells, stimulating secretion of K+ into the tubular lumen. Reabsorption of sodium in the collecting duct occurs through selective sodium channels, which create an electronegative charge within the tubular lumen relative to the tubular epithelial cell, which in turn promotes secretion of H+ and K+ into the lumen. Be familiar with the renal causes of normal anion gap (hyperchloremic) metabolic acidosis including: 1. due to chronic kidney disease. As the # of nephrons decrease w/progression, there is a proportional decrease in production of am Continue reading >>
5.4 Metabolic Acidosis - Metabolic Effects
5.4 Metabolic Acidosis - Metabolic Effects A metabolic acidosis can cause significant physiological effects, particularly affecting the respiratory and cardiovascular systems. Hyperventilation ( Kussmaul respirations ) - this is the compensatory response Shift of oxyhaemoglobin dissociation curve (ODC) to the right Decreased 2,3 DPG levels in red cells (shifting the ODC back to the left) Sympathetic overactivity (incl tachycardia, vasoconstriction,decreased arrhythmia threshold) Resistance to the effects of catecholamines Increased bone resorption (chronic acidosis only) Shift of K+ out of cells causing hyperkalaemia 5.4.2 Some Effects have Opposing Actions. The cardiac stimulatory effects of sympathetic activity and release of catecholamines usually counteract the direct myocardial depression while plasma pH remains above 7.2. At systemic pH values less than this, the direct depression of contractility usually predominates. The direct vasodilatation is offset by the indirect sympathetically mediated vasoconstriction and cardiac stimulation during a mild acidosis. The venoconstriction shifts blood centrally and this causes pulmonary congestion. Pulmonary artery pressure usually rises during acidosis. The shift of the oxygen dissociation curve to the right due to the acidosis occurs rapidly. After 6 hours of acidosis, the red cell levels of 2,3 DPG have declined enough to shift the oxygen dissociation curve (ODC) back to normal. Acidosis is commonly said to cause hyperkalaemia by a shift of potassium out of cells. The effect on potassium levels is extremely variable and indirect effects due to the type of acidosis present are much more important. For example hyperkalaemia is due to renal failure in uraemic acidosis rather than the acidosis. Significant potassium loss du Continue reading >>
Acid-base Imbalance - An Overview | Sciencedirect Topics
Ahmad Bilal Faridi, Lawrence S. Weisberg, in Critical Care Medicine (Third Edition) , 2008 Acid-base disorders are revealed most commonly through the basic metabolic chemistry panel, when the plasma bicarbonate concentration is noted to be outside the normal range. If the bicarbonate is low and if the anion gap is clearly elevated on that sample, a diagnosis of high anion gap metabolic acidosis can be made with some confidence, keeping in mind the pitfalls in the interpretation of the anion gap mentioned earlier.7 If the bicarbonate is low and the anion gap normal, two possibilities exist: either a hyperchloremic metabolic acidosis or a respiratory alkalosis with metabolic compensation. These two entities can be distinguished by examination of the blood pH and blood gases, a low pH being diagnostic of the former. If the bicarbonate concentration is high, again there are two alternative diagnoses, requiring blood pH measurement for their differentiation: either a metabolic alkalosis or metabolic compensation for a respiratory acidosis. Once the primary disturbance has been identified, the astute clinician, recognizing the possibility of a mixed disturbance, is obligated to ask, Is that all there is? This question can be answered only by an understanding of the rules of normal compensation for simple acid-base disorders (see Table 58-1).2 Knowing at least the expected direction of compensation will allow the clinician to diagnose the most obvious mixed disturbances. For example, if the pH is low, the bicarbonate is low, and the pco2 is above 40 torr, there is clearly a mixed metabolic and respiratory acidosis. Similarly, if the pH is high, the bicarbonate is high, and the pco2 is below 40 torr, the diagnosis is a mixed respiratory and metabolic alkalosis. More subtle mix Continue reading >>
Acute/chronic Acidosis/alkalosis And Potassium Excretion
SDN members see fewer ads and full resolution images. Join our non-profit community! Acute/Chronic Acidosis/Alkalosis and Potassium excretion This is my first post on sdn. I am hoping someone will be able to help me out with this. While watching Dr Kudrath's physio lecture on Renal physio, I was not entirely able to understand the differences in Potassium excretion in the cases of acute and chronic acidosis, and acute and chronic alkalosis. So far, this is the explanation I came up with. In acute acidosis, we get hyperkalemia --> increased Potassium filtration --> increased Potassium in cortical collecting duct --> less driving force for Potassium excretion-->less Potassium excretion. In chronic acidosis, we still have hyperkalemia, but due to decreased Sodium reabsorption in PCT (high H+ in PCT --> low Na+ reabsorption in PCT-->low water retention in PCT), we will get increased tubular flow in cortical collecting ducts. This will lead to cancellation of the effect of hyperkalemia on driving force, in fact increasing driving force for potassium excretion, and finally leading to increased potassium excretion. In chronic or acute alkalosis, we have less potassium in tubular fluid, which causes the opposite of what happened in acute acidosis, leading to increased potassium excretion. Are these explanations right? do they even make sense? If they're wrong or inaccurate, I'd appreciate any help with them. Also, I apologize for the somewhat lengthy post The key concept here is to distinguish the difference between an acute and a chronic acid/base disturbance. In an acute acidosis/alkalosis, renal compensation has not kicked in yet, so think about potassium levels in terms of the whole body (rather than the kidney). Cells carry a H/K exchanger and this means that in states of Continue reading >>
Effects Of Ph On Potassium: New Explanations For Old Observations
Go to: Abstract Maintenance of extracellular K+ concentration within a narrow range is vital for numerous cell functions, particularly electrical excitability of heart and muscle. Potassium homeostasis during intermittent ingestion of K+ involves rapid redistribution of K+ into the intracellular space to minimize increases in extracellular K+ concentration, and ultimate elimination of the K+ load by renal excretion. Recent years have seen great progress in identifying the transporters and channels involved in renal and extrarenal K+ homeostasis. Here we apply these advances in molecular physiology to understand how acid-base disturbances affect serum potassium. The effects of acid-base balance on serum potassium are well known.1 Maintenance of extracellular K+ concentration within a narrow range is vital for numerous cell functions, particularly electrical excitability of heart and muscle.2 However, maintenance of normal extracellular K+ (3.5 to 5 mEq/L) is under two potential threats. First, as illustrated in Figure 1, because some 98% of the total body content of K+ resides within cells, predominantly skeletal muscle, small acute shifts of intracellular K+ into or out of the extracellular space can cause severe, even lethal, derangements of extracellular K+ concentration. As described in Figure 1, many factors in addition to acid-base perturbations modulate internal K+ distribution including insulin, catecholamines, and hypertonicity.3,4 Rapid redistribution of K+ into the intracellular space is essential for minimizing increases in extracellular K+ concentration during acute K+ loads. Second, as also illustrated in Figure 1, in steady state the typical daily K+ ingestion of about 70 mEq/d would be sufficient to cause large changes in extracellular K+ were it not for Continue reading >>
Potassium And Acidosis
Balance among electrically charged atoms and molecules is essential to maintaining chemical equilibrium in your body. Potassium is the most abundant, positively charged atom inside your cells. Because acids and potassium both have a positive electrical charge in your body, their concentrations are interdependent. Medical conditions that cause an overabundance of acids in your blood, known as acidosis, may affect your blood potassium level, and vice versa. Video of the Day Metabolic acidosis is an abnormally low blood pH caused by overproduction of acids or failure of your kidneys to rid the body of acids normally. With metabolic acidosis, your blood has an abnormally high level of positively charged hydrogen atoms, or hydrogen ions. To reduce the acidity of your blood, hydrogen ions move from your circulation into your cells in exchange for potassium. The exchange of hydrogen for potassium ions helps relieve the severity of acidosis but may cause an abnormally high level of blood potassium, or hyperkalemia. Drs. Kimberley Evans and Arthur Greenberg reported in a September 2005 article published in the "Journal of Intensive Care Medicine" that there is a 0.3 to 1.3 mmol/L increase in blood potassium for every 0.1 decrease in pH with metabolic acidosis. Metabolic Acidosis Recovery Correction of the underlying medical problem responsible for metabolic acidosis typically leads to normalization of your blood pH. Although blood potassium is typically elevated with metabolic acidosis, a substantial amount of your total body potassium stores can be lost through the kidneys, causing a total body deficit. As your blood pH returns to normal, potassium moves from your bloodstream back into your cells. If your total body potassium stores have been depleted, your blood concentration Continue reading >>
Payperview: Serum Potassium Concentration In Acidemic States - Karger Publishers
Serum Potassium Concentration in Acidemic States I have read the Karger Terms and Conditions and agree. It has been generally accepted that acidosis results in hyperkalemia because of shifts of potassium from the intracellular to the extracellular compartment. There is ample clinical and experimental evidence, however, to support the conclusion that uncomplicated organic acidemias do not produce hyperkalemia. In acidosis associated with mineral acids (respiratory acidosis, end-stage uremic acidosis, NH4CI- or CaCl2-induced acidosis), acidemia per se, results in predictable increases in serum potassium concentration. In acidosis associated with nonmineral organic acids (diabetic and alcoholic acidosis, lactic acidosis, methanol and the less common forms of organic acidemias secondary to methylmalonic and isovaleric acids, and ethylene glycol, paraldehyde and salicylate intoxications), serum potassium concentration usually remains within the normal range in uncomplicated cases. A number of factors, however, may be responsible for hyperkalemia in some of these patients other than the acidemia per se. These include dehydration and renal hypoperfusion, preexisting renal disease, hypercatabolism, diabetes mellitus, hypoaldosteronism, the status of potassium balance, and therapy. The mechanism(s) of this differing effect of mineral and organic acidemias on transmembrane movement of potassium remains undefined. The prevalent hypothesis, however, favors the free penetrance of the organic anion into cells without creating a gradient for the hydrogen ions and, thus, obviating the efflux of intracellular potassium. The importance of the presence of hyperkalemia in clinical states of organic acidemias is obvious. A search for the complicating factors reviewed above should be undert Continue reading >>
Why Does Acidosis Cause Potassium To Shift From Icf To Ecf ? : Medicalschool
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Potassium Shifts - Renal - Medbullets Step 1
A 22-year-old man presents to the emergency department after a crush injury to his lower extremities. He reports muscular pain, weakness, and palpitations and noticed that his urine is "tea-colored." On physical exam, there is tenderness upon palpation of his lower extremities and 4-/5 power in the same area. Urinalysis is heme positive. Laboratory testing is significant for a potassium level of 6.5 mEq/L and creatinine kinase level of 1,500 units/L. An electrocardiogram is shown. (Rhabdomyolysis resulting in hyperkalemia) The major intracellular cation is potassium and magnesium cells contain approximately 98% of the body's potassium the sodium-potassium-ATPase (Na+/K+ -ATPase) pump within the cellular membrane maintains this potassium distribution between the intracellular and extracellular compartments potassium is the major determinant of the resting membrane potential across the cell membrane normal potassium homeostasis is essential for proper action potential generation in muscle and neural tissue intracellular and extracellular potassium distribution mainly accomplished by principal cells in the nephron Disruptions in potassium homeostasis can result in hyperkalemia or hypokalemia these disruptions can have a number of clinical consequences defined as a potassium level in the blood that is > 5.0-5.5 mEq/L defined as a potassium level in the blood that is < 3.5 mEq/L Continue reading >>
Metabolic Acidosis: Practice Essentials, Background, Etiology
Metabolic acidosis is a clinical disturbance characterized by an increase in plasma acidity. Metabolic acidosis should be considered a sign of an underlying disease process. Identification of this underlying condition is essential to initiate appropriate therapy. (See Etiology, DDx, Workup, and Treatment.) Understanding the regulation of acid-base balance requires appreciation of the fundamental definitions and principles underlying this complex physiologic process. Go to Pediatric Metabolic Acidosis and Emergent Management of Metabolic Acidosis for complete information on those topics. An acid is a substance that can donate hydrogen ions (H+). A base is a substance that can accept H+ ions. The ion exchange occurs regardless of the substance's charge. Strong acids are those that are completely ionized in body fluids, and weak acids are those that are incompletely ionized in body fluids. Hydrochloric acid (HCl) is considered a strong acid because it is present only in a completely ionized form in the body, whereas carbonic acid (H2 CO3) is a weak acid because it is ionized incompletely, and, at equilibrium, all three reactants are present in body fluids. See the reactions below. The law of mass action states that the velocity of a reaction is proportional to the product of the reactant concentrations. On the basis of this law, the addition of H+ or bicarbonate (HCO3-) drives the reaction shown below to the left. In body fluids, the concentration of hydrogen ions ([H+]) is maintained within very narrow limits, with the normal physiologic concentration being 40 nEq/L. The concentration of HCO3- (24 mEq/L) is 600,000 times that of [H+]. The tight regulation of [H+] at this low concentration is crucial for normal cellular activities because H+ at higher concentrations can b Continue reading >>
Hypokalemia And Hyperkalemia
Physiology of Potassium Handling Potassium (K+) is the most abundant cation in the body. About 90% of total body potassium is intracellular and 10% is in extracellular fluid, of which less than 1% is composed of plasma. The ratio of intracellular to extracellular potassium determines neuromuscular and cardiovascular excitability, which is why serum potassium is normally regulated within a narrow range of 3.5 to 5.0 mmol/L. Dietary K+ intake is highly variable, ranging from as low as 40 mmol/day to more than 100 mmol/day.1, 2 Homeostasis is maintained by two systems. One regulates K+ excretion, or external balance through the kidneys and intestines, and the second regulates K+ shifts, or internal balance between intracellular and extracellular fluid compartments. Internal balance is mainly mediated by insulin and catecholamines. Cellular Shifts Ingested K+ is absorbed rapidly and enters the portal circulation, where it stimulates insulin secretion. Insulin increases Na+,K+-ATPase activity and facilitates potassium entry into cells, thereby averting hyperkalemia. β2-Adrenergic stimulation also promotes entry of K+ into cells through increased cyclic adenosine monophosphate (cAMP) activation of Na+,K+-ATPase. Renal Handling An increase in extracellular potassium concentration also stimulates aldosterone secretion (via angiotensin II), and aldosterone increases K+ excretion. In the steady state, K+ excretion matches intake, and approximately 90% is excreted by the kidneys and 10% in the stool. Renal K+ excretion is mediated by aldosterone and sodium (Na+) delivery (glomerular filtration rate [GFR]) in principal cells of the collecting ducts.3 K+ is freely filtered by the glomerulus, and almost all the filtered K+ is reabsorbed in the proximal tubule and loop of Henle (Fig. Continue reading >>
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Metabolic Acidosis And Alkalosis
Page Index Metabolic Acidosis. Metabolic Alkalosis Emergency Therapy Treating Metabolic Acidosis Calculating the Dose Use Half the Calculated Dose Reasons to Limit the Bicarbonate Dose: Injected into Plasma Volume Fizzes with Acid Causes Respiratory Acidosis Raises Intracellular PCO2 Subsequent Residual Changes Metabolic Acidosis. The following is a brief summary. For additional information visit: E-Medicine (Christie Thomas) or Wikepedia Etiology: There are many causes of primary metabolic acidosis and they are commonly classified by the anion gap: Metabolic Acidosis with a Normal Anion Gap: Longstanding diarrhea (bicarbonate loss) Uretero-sigmoidostomy Pancreatic fistula Renal Tubular Acidosis Intoxication, e.g., ammonium chloride, acetazolamide, bile acid sequestrants Renal failure Metabolic Acidosis with an Elevated Anion Gap: lactic acidosis ketoacidosis chronic renal failure (accumulation of sulfates, phosphates, uric acid) intoxication, e.g., salicylates, ethanol, methanol, formaldehyde, ethylene glycol, paraldehyde, INH, toluene, sulfates, metformin. rhabdomyolysis For further details visit: E-Medicine (Christie Thomas). Treating Severe Metabolic Acidosis. The ideal treatment for metabolic acidosis is correction of the underlying cause. When urgency dictates more rapid correction, treatment is based on clinical considerations, supported by laboratory evidence. The best measure of the level of metabolic acidosis is the Standard Base Excess (SBE) because it is independent of PCO2. If it is decided to administer bicarbonate, the SBE and the size of the treatable space are used to calculate the dose required: Metabolic Alkalosis Etiology: Primary Metabolic alkalosis may occur from various causes including: Loss of acid via the urine, stools, or vomiting Transfer of Continue reading >>
- Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)*
- Ultraviolet Radiation Suppresses Obesity and Symptoms of Metabolic Syndrome Independently of Vitamin D in Mice Fed a High-Fat Diet
- Why Diabetes Is Dangerous: How to Recognize the Signs of this Metabolic Disease
