HYPERKALEMIA: Intracellular Shift

HYPERKALEMIA: Reduced ExcretionHyperkalemiaSerum potassium > 5.5 mmol/L Transcellular ShiftReduced Excretion Principal Cell Problem TTKG < 7Decreased Glomerular Filtration RateIncreased CreatinineHigh Renin Low AldosteroneLow ReninLow Aldosterone Chronic renal failure AKI ENaC blockers AIN/CIN Obstruction Diabetic nephropathy ?2 antagonism NSAIDs High Renin High Aldosterone ACEi/ARB Adrenal insufficiency HeparinIncreased Intake (IV potassium with reduced excretion) Reduced flow through distal nephron TTKG > 7, Urine Na < 20meq/L Low EABV (e.g., CHF, cirrhosis, hypotension) Exclude pseudohyperkalemia Leukocytosis, thrombocytosis, hemolysisTTKG = (KUrine x OsmSerum)/(KSerum x OsmUrine)