Potassium metabolism

In man, mechanisms for potassium excretion are complex and highly developed, while potassium conservation is potentially inadequate. Potassium balance is regulated by alterations in excretion in the distal renal tubule, where mineralocorticoid hormones and Na-K ATPase are the major regulating factors. The distribution of potassium across cell membranes is influenced by changes in acid-base status, by pancreatic hormones and by the autonomic nervous system. Potassium stimulates insulin and aldosterone secretion and increases Na-K ATPase in the distal nephron, so promoting its own redistribution or excretion. Emergency management of hyperkalaemia is best effected by promoting cell-entry of potassium, rather than renal excretion. The speed of replacement of deficits is always limited by the small extracellular potassium pool.