Causes of Hyperkalemia

l. Pseudohyperkalemia

  A Cellular efflux; thrombocytosis, erythrocytosis, leukocytosis, in vitro hemolysis

  B. Hereditary defects in red cell membrane transport

II. Intra- to extracellular shift

  A. Acidosis

  B. Hyperosmolality; radiocontrast, hypertonic dextrose, mannitol

  C. Beta-Adrenergic antagonists (noncardioselective agents)

  D. Digoxin and related glycosides (yellow oleander, foxglove, bufadienolide)

  E. Hyperkalemic periodic paralysis

  F. Lysine, arginine, and E-aminocaproic acid (structurally similar, positively charged)

  G. Succinylcholine; thermal trauma, neuromuscular injury, disuse atrophy, mucositis, or prolonged immobilization

  H. Rapid tumor lysis

IIl. Inadequate excretion

  A. Inhibition of the renin-angiotensin-aldosterone axis; T risk of hyperkalemia when used in combination

     1. Angiotensin-converting enzyme (ACE) inhibitors

     2. Renin inhibitors; aliskiren (in combination with ACE inhibitors or angiotensin receptor blockers [ARBs])

     3. Angiotensin receptor blockers (ARBs)

     4. Blockade of the mineralocorticoid receptor: spironolactone, eplerenone, drospirenone

     5. Blockade of the epithelial sodium channel (ENaC): amiloride, triamterene, trimethoprim, pentamidine, nafamostat

  B. Decreased distal delivery

     1. Congestive heart failure

     2. Volume depletion

  C. Hyporeninemic hypoaldosteronism

     1. Tubulointerstitial diseases: syßtemic lupus erythematosus (SLE), sickle cell anemia, obstructive uropathy

     2. Diabetes, diabetic nephropathy

     3. Drugs: nonsteroidal anti-inflammatory drugs (NSAlDs), cyclooxygenase 2 (COX2) inhibitors, ß-blockers, cyclosporine, tacrolimus

     4. Chronic kidney disease, advanced age

     5. Pseudohypoaldosteronism type II

  D. Renal resistance to mineralocorticoid

     1. Tubulointerstitial diseases: SLE, amyloidosis, sickle cell anemia, obstructive uropathy, post-acute tubular necrosis

     2. Hereditary: pseudohypoaldosteronism type l; defects in the mineralocorticoid receptor or the epithelial sodium channel (ENaC)

  E. Advanced renal insufficiency

     1. Chronic kidney disease

     2. End-stage renal disease

     3. Acute oliguric kidney injury

  F. Primary adrenal insufficiency

     1. Autoimmune: Addison's disease, polyglandular endocrinopathy

     2. Infectious: HIV, cytomegalovirus, tuberculosis, disseminated fungal infection

     3. Infiltrative: amyloidosis, malignancy, metastatic cancer

     4. Drug-associated: heparin, low-molecular-weight heparin

     5. Hereditary: adrenal hypoplasia congenita, congenital lipoid adrenal hyperplasia, aldosterone synthase deficiency

     6. Adrenal hemorrhage or infarction, including in antiphospholipid syndrome



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