$Unique_ID{BRK03841} $Pretitle{} $Title{Hyperkalemia} $Subject{Hyperkalemia Hyperpotassemia High Potassium Addison's Disease ACTH Deficiency Purpura Thrombotic Thrombocytopenic } $Volume{} $Log{} Copyright (C) 1990 National Organization for Rare Disorders, Inc. 750: Hyperkalemia ** IMPORTANT ** It is possible that the main title of the article (Hyperkalemia) is not the name you expected. Please check the SYNONYM listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Hyperpotassemia High Potassium Information on the following diseases can be found in the Related Disorders section of this report: Addison's Disease ACTH Deficiency Purpura, Thrombotic Thrombocytopenic General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Hyperkalemia is an abnormally high concentration of potassium in the blood. It usually occurs due to another underlying medical condition. The body uses potassium for the contraction of muscles (including the heart) and for the functioning of many complicated proteins (enzymes). Potassium is found primarily in the skeletal muscle and bone, and participates with sodium to contribute to the normal flow between the body fluids and the cells of the body. The concentration of potassium in the body is regulated by the kidneys through excretion in urine. When the kidneys are functioning normally, the amount of potassium eaten in the diet is usually sufficient for use by the body and the excess is excreted. Chemical and hormonal influences also regulate the internal potassium balance. Secretion of the hormone insulin, which is normally stimulated by food, prevents a temporary diet-induced high level of potassium (hyperkalemia) by increasing cell absorption of potassium. The hormone aldosterone also aids in regulating the internal balance of potassium. When hyperkalemia occurs, there is an imbalance resulting from a dysfunction of these normal processes. Symptoms Individuals with hyperkalemia initially may show no symptoms. Later symptoms may include heart abnormalities which can be seen on an electrocardiogram (ECG), progressive weakness, and a type of paralysis in which muscle tone is lacking in the extremities (flaccid paralysis). Individuals with hyperkalemia may experience a loss of deep tendon reflexes, difficulties in speaking (phonation) and breathing. They may also have a slowed heartbeat (bradycardia), rapid and irregular contractions of the heart (ventricular fibrillation) and abnormally low blood pressure (hypotension). If untreated, cardiac arrest may also occur. Causes Hyperkalemia is a symptom of another underlying medical condition. It may be caused by an inflammatory disease of the kidneys (acute tubular nephrosis), acute kidney failure, excessive acid production (metabolic or diabetic acidosis), or a deficiency of the hormone aldosterone (Addison's Disease). Other causes may include multiple transfusions of stored blood, internal acid-base disturbances, sickle-cell anemia, excess sugar in the blood (hyperglycemia), and excessive dietary intake of potassium. The use of drugs which act in opposition to the hormone aldosterone (aldosterone antagonists), and muscle relaxant succinylcholine, extensive burns, severe crushing injuries which cause bleeding into soft tissue, or conditions causing bleeding in the gastrointestinal tract, may also cause hyperkalemia. Affected Population Hyperkalemia affects males and females in equal numbers. Individuals with kidney malfunction associated with diabetes (diabetic nephropathy or interstitial renal disease), an abnormally low level of the enzyme renin (hyporeninemia), or abnormally low levels of the hormone aldosterone (hypoaldosteronism), may increase the risk for hyperkalemia. Related Disorders Symptoms of the following disorders may include Hyperkalemia. Comparisons may be useful for a differential diagnosis: Addison's Disease is a disorder characterized by chronic and insufficient functioning of the outer layer of the adrenal gland (adrenal cortex). This malfunction results in a deficiency of the hormone aldosterone. Individuals with this disorder show abnormally high concentrations of potassium (hyperkalemia) and abnormally low concentrations of sodium in the blood. Symptoms may include weakness, low blood pressure and loss of appetite. (For more information on this disorder, choose "Addison" as your search term in the Rare Disease Database). ACTH Deficiency is a disorder characterized by low levels or absence of the hormone ACTH which is manufactured by the pituitary gland. Symptoms of ACTH Deficiency may include weakness, nausea, vomiting, low blood pressure, abnormally high concentrations of potassium in the blood (hyperkalemia) and lack of appetite. (For more information on this disorder, choose "ACTH Deficiency " as your search term in the Rare Disease Database). Thrombotic Thrombocytopenic Purpura (TTP) is a serious blood disorder characterized by a decrease in blood platelets, abnormal destruction of red blood cells and disturbances in the nervous system. Symptoms may include fever, fatigue, patches of purplish discoloration in the skin (purpura), weakness, kidney dysfunction and abnormally high levels of potassium in the blood (hyperkalemia). (For more information on this disorder, choose "TTP" as your search term in the Rare Disease Database). (To locate other disorders that include Hyperkalemia as a symptom, choose "Hyperkalemia" as your search term in the Rare Disease Database). Therapies: Standard An electrocardiogram for patients with hyperkalemia may assess the urgency of therapy. Treatment of Hyperkalemia may require diminished potassium in the diet or removal of potassium from the body. Depending upon the cause of Hyperkalemia, diuretics, insulin, beta-2 agonists or sodium polystyrene may be administered to increase the body's excretion of potassium. Dialysis may also be required. Periodic paralysis may be treated with the drug albuterol. Calcium gluconate may be administered to reverse certain heart abnormalities. If no ECG abnormalities are present, the drug sorbitrol may be prescribed. Other treatment is symptomatic and supportive. Therapies: Investigational This disease entry is based upon medical information available through January 1990. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Hyperkalemia, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 National Digestive Diseases Information Clearinghouse Box NDDIC Bethesda, MD 20892 (301) 468-6344 References INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 814-815, 820-824. THE MERCK MANUAL, 15th Ed.: Robert Berkow, M.D., ed.-in-chief; Merck Sharp & Dohme Laboratories, 1987. Pp. 964-965, 968-969. CARDIAC ARREST DUE TO ORAL POTASSIUM INTAKE. H.J. Schim van der Loeff et al.; INTENSIVE CARE MED (1988; issue 15(1)). Pp. 58-9). DIURETICS AND HYPERKALEMIA IN DIABETIC KETOACIDOSIS. S.A. Olczak et al.; DIABETIC MED (January, 1988; 5(1)). Pp. 68-9). NEBULIZED ALBUTEROL FOR ACUTE HYPERKALEMIA IN PATIENTS ON HEMODIALYSIS. M. Allen et al.; ANN INTERN MED (March, 1989; 110(6)). Pp. 426-9).