HYPERKALEMIA: Reduced Excretion

HYPERKALEMIA: Reduced Excretion Hyperkalemia Serum potassium > 5.5 mmol/L Transcellular Shift Reduced ExcretionPrincipal Cell Problem TTKG < 7 Decreased Glomerular Filtration RateIncreased Creatinine High Renin Low Aldosterone Low 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, hemolysis TTKG = (KUrine x OsmSerum)/(KSerum x OsmUrine)