Hyperkalemia increased potassium intake

Hyperkalemia is defined as a serum potassium concentration greater than 5 mEq/L (5 mmol/L). Manifestations of hyperkalemia include muscle weakness, paresthesias, hypotension, ECG changes (e.g., peaked T waves, shortened QT intervals, and wide QRS complexes), cardiac arrhythmias, and a decreased pH. Causes of hyperkalemia fall into three broad categories (1) increased potassium intake (2) decreased potassium excretion and (3) potassium release from the intracellular space. 

Primary causes of true hyperkalemia are increased potassium intake, decreased potassium excretion, tubular unresponsiveness to aldosterone, and redistribution of potassium to the extracellular space. 

Hyperkalemia Associated with Increased Potassium Intake... 

Hyperkalemia (increase in potassium in the blood), a serious event, may be seen with the administration of potassium-sparing diuretics. Hyperkalemia is most likely to occur in patients with an inadequate fluid intake and urine output, those with diabetes or renal disease tiie elderly, and those who are severely ill. In patients taking spironolactone, gynecomastia (breast enlargement in tiie male) may occur. This reaction appears to be related to both dosage and duration of therapy. The gynecomastia is usually reversible when therapy is discontinued, but in rare instances, some breast enlargement may remain. 

Patients with CKD should avoid abrupt increases in dietary intake of potassium because the kidney is unable to increase potassium excretion with an acute potassium load, particularly in latter stages of the disease. Hyperkalemia resulting... 

Amiloride is a therapeutic option in reducing potassium losses in patients receiving amphotericin. When it was given to 19 oncology patients with marked amphotericin-induced potassium depletion mean serum potassium concentrations increased in the 5 days before and after administration (from 3.4 to 3.9 mmol/1) (8). There was also a trend toward reduced potassium supplementation (48 versus 29 mmol/day). Adverse reactions were limited to hyperkalemia in two patients who took amiloride 20 mg/day and a high potassium intake. 

Hyperkalemia develops when potassium intake exceeds excretion (i.e., elevated total body stores), or when the transcellular distribution of potassium is disturbed (i.e., normal total body stores). Generally, there are four primary causes of true hyperkalemia (1) increased... 

The kidneys excrete 80% of the daily potassium intake. Therefore when the kidney is unable to excrete potassium appropriately, as in acute renal failure and CKD, potassium is retained and often results in hyperkalemia. Moreover, many drugs can inhibit the kidney s ability to excrete potassium by inhibiting aldosterone and thus contribute to an increase in serum potassium levels. 

The metabolic acidosis associated with hyperkalemic distal (type IV) RTA with hyporeninemic-hypoaldosteronemia that is often seen in patients with diabetes meUitus may be corrected by the treatment of hyperkalemia alone (see Chap. 50). The use of supplemental alkali (1 to 2 mEq/kg per day) to increase sodium intake and stimulate distal tubular potassium secretion may be beneficial. A minority of patients require the administration of pharmacologic amounts of fludrocortisone." Type TV RTA resulting from a generalized distal tubular disorder often responds to low doses of alkali (1.5 to 2.0 mEq/kg per day). ° Corrections of the acidosis along with modest dietary potassium restriction (to 1 mEq/kg per day) wfll often result in the maintenance of serum potassium levels of 5 mEq/L or less. 

The human body has a limited capacity to increase body stores of potassium. The major causes of hyperkalemia are excess potassium intake and mixed doses of potassium and sodium electrolyte solutions (Mahfoud et al. 2003), reduced renal losses (acute renal failure, end-stage renal disease, mineralocorticoid deficiency, potassiumsparing diuretics) and redistributions of potassium (hemolyses, necrosis, muscle injury, catecholamine antagonists, insulin deficiency, abnormal skeletal muscle sodium channels) (Peterson 1997). Increased intake by itself is rarely the sole cause of significant hyperkalemia. However, sustained hyperkalemia usually indicates an underlying defect in renal potassium excretion or impaired potassium distribution (KCl supplements or salt substitutes). The... 

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