Clinical manifestations of hyperkalemia in adults
- David B Mount, MD
David B Mount, MD
- Assistant Professor of Medicine
- Harvard Medical School
Hyperkalemia is a common clinical problem that is most often due to impaired urinary potassium excretion due to acute or chronic kidney disease and/or disorders or drugs that inhibit the renin-angiotensin-aldosterone axis. Therapy for hyperkalemia due to potassium retention is ultimately aimed at inducing potassium loss [1-3]. In some cases, the primary problem is movement of potassium out of the cells, even though the total body potassium may be reduced. Redistributive hyperkalemia most commonly occurs in uncontrolled hyperglycemia (eg, diabetic ketoacidosis or hyperosmolar hyperglycemic state). (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment", section on 'Potassium replacement'.)
The clinical manifestations of hyperkalemia will be reviewed here. The causes, diagnosis, treatment, and prevention of hyperkalemia are discussed separately. (See "Causes and evaluation of hyperkalemia in adults" and "Treatment and prevention of hyperkalemia in adults".)
The most serious manifestations of hyperkalemia are muscle weakness or paralysis, cardiac conduction abnormalities, and cardiac arrhythmias. These manifestations usually occur when the serum potassium concentration is ≥7.0 meq/L with chronic hyperkalemia or possibly at lower levels with an acute rise in serum potassium. Patients with skeletal muscle or cardiac manifestations typically have one or more of the characteristic ECG abnormalities associated with hyperkalemia.
Other manifestations in hyperkalemic patients may be related to the cause of the hyperkalemia, such as polyuria and polydipsia with uncontrolled diabetes.
Severe muscle weakness or paralysis — Hyperkalemia can cause ascending muscle weakness that begins with the legs and progresses to the trunk and arms [4-6]. This can progress to flaccid paralysis, mimicking Guillain-Barré syndrome [5,6]. Sphincter tone and cranial nerve function are typically intact, and respiratory muscle weakness is rare . These manifestations resolve with correction of the hyperkalemia.
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