Hyperkalaemia

Potassium is the predominant intracellular cation. This means that serum potassium concentrations are a poor indicator of total body potassium, as only 2% exists in the extracellular fluid. It is disturbances in the balance between the extracellular and intracellular concentrations that cause raised serum potassium levels, which may even occur when the total body potassium is low. As the patient has a serum potassium level of 6.6mmol/L, which is far higher than the upper limit of the reference range (3.3 – 4.7 mmol/L) it appears the patient is hyperkalaemic. The distribution of potassium in the body is about 150mmol/L in the intracellular fluid (ICF), and about 4mmol/L in the extracellular fluid (ECF). The ICF concentration is determined by the movement of cations across the cell membrane, so anything causing movement of potassium out of the cell will result in hyperkalaemia. The ECF concentration is determined by intake and excretion of potassium. In normal non-diseased individuals the amount of dietary potassium is equal to the amount exc

The patient must be given urgent treatment to counteract the hyperkalaemia as the serum potassium levels are over 6.5mmol/L. Intravenous calcium gluconate can be given to treat the neuromuscular effects, although this is short-lived. The movement of potassium into cells can be stimulated with glucose and insulin and salbutamol can be used to activate sodium/potassium ATPase. Bicarbonate can be used for treatment if acidosis is identified as the cause of the hyperkalaemia. Treatment with ion-exchange resins or renal kidney dialysis may also be needed. Once the patient has been treated to return the serum potassium levels to normal, any further treatment, once a diagnosis of any underlying disease has been made, can be commenced.

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