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A 77-Year-Old Man with Heparin-Induced Aldosterone Suppression Causing Hyperkalemia
Jonathan Kovacs1, Samer Talib1, Abdallah Khashan1
1Department of Internal Medicine, Hackensack Meridian Health, Raritan Bay Medical Center, Perth Amboy, NJ, USA.
The American Journal of Case Reports
|July 21, 2022
Summary
Heparin can infrequently cause dangerously high serum potassium levels by suppressing aldosterone. Promptly identifying heparin as the cause is crucial for patient safety and can be life-saving.
Area of Science:
- Nephrology
- Endocrinology
- Cardiology
Background:
- Heparin anticoagulation can infrequently cause hyperkalemia.
- This occurs via reduced adrenal angiotensin II receptors, leading to aldosterone suppression and impaired sodium excretion.
Observation:
- A 77-year-old male with COVID-19 and myocardial infarction developed hyperkalemia during unfractionated heparin infusion.
- Hyperkalemia resolved upon heparin discontinuation and recurred upon re-initiation, confirming heparin as the cause.
Findings:
- The patient's hyperkalemia was not due to hemolysis or other medications.
- Heparin's effect on serum potassium was reversible upon cessation of the drug.
Implications:
- Acutely elevated serum potassium can cause severe weakness, paralysis, and fatal cardiac arrhythmias.
- Clinicians must consider heparin-induced hyperkalemia, especially in hospitalized patients, and promptly identify this reversible cause.
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