Hyperkalemia - Differential Diagnosis Framework



PseudoHyperkalemia:

 • Lab error

 • Traumatic venipuncture

 • Hemolysis, thrombocytosis, leukocytosis

 • Clenching of fist during phlebotomy



High Suspicion for Hyperkalemia:

 • CKD

 • Poorly controlled DM

 • Chemotherapy

 • Burns

 • Trauma/Crush injury

 • Blood transfusion

 • HTN and edema

 • Jaundice/Hemolytic reactions



Common Drugs Causing Hyperkalemia:

 • Digoxin

 • K sparing diuretics

 • NSAIDs

 • ACE Inhibitors

 • Recent IV potassium

 • Beta blockers

 • Antibiotics: amoxicillin

 • Heparins

 • Tacrolimus

 • TMP-SMZ

 • Penicillin G



Intracellular Shift:

 • K release due to cell lysis:

	- Hemolysis

	- Transfusion reaction

	- Tumor lysis syndrome

	- Rhabdomyolysis, burns, trauma

	- Ischemic colonic necrosis

 • K release with intact cell membrane

	- Beta adrenergic receptor blockers

	- Succinylcholine

	- Hyperosmolar states (Uncontrolled diabetes, glucose infusions)

	- Metabolic acidosis

	- Hyperkalemia Periodic paralysis

	- Insulin deficiency or resistance



Impaired Renal Excretion:

 • Addison’s disease/Hypoaldosteronism

 • Acquired hyporeninemic hypoaldosteronism

 • Mineralocorticoid deficiency

 • Renal insufficiency/Failure

 • SLE

 • Type IV RTA

 • Renal hypoperfusion



Increased K Intake:

 1. Medications

 2. K supplement

 3. Blood transfusion

 4. TPN

 5. Food - Avoid in CRF: 

	• Dried fruits, Seaweed, Nuts, molasses, Avocados, Lima beans

	• Vegetables: spinach, potatoes, tomatoes, broccoli, carrots

	• Fruits: kiwis, mangoes, oranges, bananas, cantaloupe



Updated Version Here: https://www.grepmed.com/images/12834



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