Hyperkalemia: a Potentially Lethal Clinical Condition

∑ Hyperkalemia develops when the regulation between potassium intake and potassium excretion, or the distribution between intraand extracellular potassium is disturbed. It is a common, silent, and potentially lethal clinical condition, which seldom occurs in patients with normal renal function. Clinically, the most important effect of hyperkalemia is that which the condition has on the myocardium, but it also affects neuromuscular, gastrointestinal, and hormonal functioning. The management of hyperkalemia requires exclusion of pseudohyperkalemia, assessment of the urgency for treatment, and institution of appropriate therapy. The initial treatment for life-threatening hyperkalemia should always include insulin plus glucose, as the hypokalemic response to insulin is both prompt and predictable. Combined treatment with β2-agonists and insulin is also effective, but the most rapid method of potassium removal is hemodialysis.