Hyperkalemia: mechanisms, etiology, and treatment

Hyperkalemia may follow failure of glomerular filtration or tubular secretion of potassium. Tubular secretory failure may be secondary to deficient aldosterone or tubular insensitivity to this hormone. In either case glomerular insufficiency magnifies the problem. Increased potassium intake alone is a rare cause of increased serum potassium. The well recognized sequential treatment of hyperkalemia is reviewed. Most important is the establishment of the cause of hyperkalemia as these emergency measures are being taken. A history of drug intake, establishment of the acid-base status of the patient and the presence of underlying disease must be ascertained. The management of hyperkalemia remains an intriguing challenge in the office and hospital practice of medicine.