Hyperkalemia history and symptoms


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]

Overview
Hyperkalemia is an elevated blood level (above 5.0 mmol/L) of the electrolyte potassium. Hyperkalemia often has no symptoms. Occasionally, people may have the following symptoms:Irregular heartbeat, nausea, slow, weak, or absent pulse. Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias. A detailed history taking is very helpful in diagnosing the cause of hyperkalemia.

Symptoms
Hyperkalemia often has no symptoms and the problem may be detected during screening blood tests for another medical disorder, or it may only come to medical attention after complications have developed, such as cardiac arrhythmia or sudden death. Patients may present with the symptoms such as, irregular heartbeat, nausea, slow, weak, or absent pulse. Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias. Symptoms are fairly nonspecific and may include:
 * Malaise
 * Palpitations
 * Muscle weakness
 * Mild breathlessness may indicate metabolic acidosis, one of the settings in which hyperkalemia may occur.

History
A detailed history taking is very helpful in diagnosing the cause of hyperkalemia.
 * Dietary history (diets with low sodium and rich in potassium)
 * Diets recommended for patients with cardiac disease, hypertension, and diabetes mellitus
 * Potassium supplements in herbal supplements, salt substitutes
 * Fruits, dried fruits, juices, banana and vegetables


 * Medications history (drugs causing a decreased excretion of potassium)
 * Nonsteroidal anti-inflammatory drugs
 * Angiotensin-converting enzyme inhibitors
 * Angiotensin receptor blockers (potassium-sparing diuretics, especially popular in the treatment of cirrhosis and congestive heart failure)
 * Cyclosporine or tacrolimus
 * Antibiotics, such as pentamidine or trimethoprim/sulfamethoxazole


 * Medical history
 * Renal failure
 * Diabetes mellitus
 * Sickle cell disease or trait
 * Urinary tract obstruction - Type IV renal tubular acidosis, also called hyperkalemic renal tubular acidosis. It can be seen with polycystic kidney disease, amyloidosis and diabetes mellitus.
 * The combination of abdominal pain, hypoglycemia and hyperpigmentation, often in the context of a history of other autoimmune disorders, may be signs of Addison's disease, itself a medical emergency.