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. 2001 Dec;77(914):759–764. doi: 10.1136/pmj.77.914.759

Hypokalaemia and hyperkalaemia

A Rastergar 1, M Soleimani 1
PMCID: PMC1742191  PMID: 11723313

Abstract

Disturbances in potassium homoeostasis presenting as low or high serum potassium are common, especially among hospitalised patients. Given the fact that untreated hypokalaemia or hyperkalaemia is associated with high morbidity and mortality, it is critical to recognise and treat these disorders promptly. In this article, normal potassium homoeostasis is reviewed initially and then a pathophysiological approach to work-up and management of hypokalaemia and hyperkalaemia is presented. Recent advances with respect to the role of kidney in handling of the potassium, the regulation of renal ion transporters in hypokalaemia, and treatment of hypokalaemia and hyperkalaemia will be discussed.


Keywords: hypokalaemia; hyperkalaemia; potassium

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Selected References

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  1. Adrogué H. J., Madias N. E. Changes in plasma potassium concentration during acute acid-base disturbances. Am J Med. 1981 Sep;71(3):456–467. doi: 10.1016/0002-9343(81)90182-0. [DOI] [PubMed] [Google Scholar]
  2. Allon M., Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int. 1990 Nov;38(5):869–872. doi: 10.1038/ki.1990.284. [DOI] [PubMed] [Google Scholar]
  3. Amlal H., Habo K., Soleimani M. Potassium deprivation upregulates expression of renal basolateral Na(+)-HCO(3)(-) cotransporter (NBC-1). Am J Physiol Renal Physiol. 2000 Sep;279(3):F532–F543. doi: 10.1152/ajprenal.2000.279.3.F532. [DOI] [PubMed] [Google Scholar]
  4. Amlal H., Krane C. M., Chen Q., Soleimani M. Early polyuria and urinary concentrating defect in potassium deprivation. Am J Physiol Renal Physiol. 2000 Oct;279(4):F655–F663. doi: 10.1152/ajprenal.2000.279.4.F655. [DOI] [PubMed] [Google Scholar]
  5. Amlal H., Wang Z., Soleimani M. Potassium depletion downregulates chloride-absorbing transporters in rat kidney. J Clin Invest. 1998 Mar 1;101(5):1045–1054. doi: 10.1172/JCI686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Blumberg A., Weidmann P., Shaw S., Gnädinger M. Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure. Am J Med. 1988 Oct;85(4):507–512. doi: 10.1016/s0002-9343(88)80086-x. [DOI] [PubMed] [Google Scholar]
  7. Brown M. J., Brown D. C., Murphy M. B. Hypokalemia from beta2-receptor stimulation by circulating epinephrine. N Engl J Med. 1983 Dec 8;309(23):1414–1419. doi: 10.1056/NEJM198312083092303. [DOI] [PubMed] [Google Scholar]
  8. DeFronzo R. A., Felig P., Ferrannini E., Wahren J. Effect of graded doses of insulin on splanchnic and peripheral potassium metabolism in man. Am J Physiol. 1980 May;238(5):E421–E427. doi: 10.1152/ajpendo.1980.238.5.E421. [DOI] [PubMed] [Google Scholar]
  9. DuBose T. D., Jr Hyperkalemic hyperchloremic metabolic acidosis: pathophysiologic insights. Kidney Int. 1997 Feb;51(2):591–602. doi: 10.1038/ki.1997.85. [DOI] [PubMed] [Google Scholar]
  10. Ethier J. H., Kamel K. S., Magner P. O., Lemann J., Jr, Halperin M. L. The transtubular potassium concentration in patients with hypokalemia and hyperkalemia. Am J Kidney Dis. 1990 Apr;15(4):309–315. doi: 10.1016/s0272-6386(12)80076-x. [DOI] [PubMed] [Google Scholar]
  11. Fulop M. Serum potassium in lactic acidosis and ketoacidosis. N Engl J Med. 1979 May 10;300(19):1087–1089. doi: 10.1056/NEJM197905103001905. [DOI] [PubMed] [Google Scholar]
  12. Gennari F. J. Hypokalemia. N Engl J Med. 1998 Aug 13;339(7):451–458. doi: 10.1056/NEJM199808133390707. [DOI] [PubMed] [Google Scholar]
  13. Kamel K. S., Quaggin S., Scheich A., Halperin M. L. Disorders of potassium homeostasis: an approach based on pathophysiology. Am J Kidney Dis. 1994 Oct;24(4):597–613. doi: 10.1016/s0272-6386(12)80220-4. [DOI] [PubMed] [Google Scholar]
  14. Ponce S. P., Jennings A. E., Madias N. E., Harrington J. T. Drug-induced hyperkalemia. Medicine (Baltimore) 1985 Nov;64(6):357–370. doi: 10.1097/00005792-198511000-00001. [DOI] [PubMed] [Google Scholar]
  15. Rashid A., Hamilton S. R. Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (Kayexalate) in sorbitol: an underrecognized condition. Am J Surg Pathol. 1997 Jan;21(1):60–69. doi: 10.1097/00000478-199701000-00007. [DOI] [PubMed] [Google Scholar]
  16. Silver R. B., Soleimani M. H+-K+-ATPases: regulation and role in pathophysiological states. Am J Physiol. 1999 Jun;276(6 Pt 2):F799–F811. doi: 10.1152/ajprenal.1999.276.6.F799. [DOI] [PubMed] [Google Scholar]
  17. Soleimani M., Bergman J. A., Hosford M. A., McKinney T. D. Potassium depletion increases luminal Na+/H+ exchange and basolateral Na+:CO3=:HCO3- cotransport in rat renal cortex. J Clin Invest. 1990 Oct;86(4):1076–1083. doi: 10.1172/JCI114810. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Velázquez H., Perazella M. A., Wright F. S., Ellison D. H. Renal mechanism of trimethoprim-induced hyperkalemia. Ann Intern Med. 1993 Aug 15;119(4):296–301. doi: 10.7326/0003-4819-119-4-199308150-00008. [DOI] [PubMed] [Google Scholar]

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