Talk:Hyperkalemia

Possible confusion in Mechanism section

In reference to the sentence in that section: "Increased extracellular potassium levels result in depolarization of the membrane potentials of cells due to the increase in the equilibrium potential of potassium."

The K+ equilibrium potential (E_K) becomes LESS negative with hyperkalemia (as can be calculated with the Nernst equation). The phrasing "increase in" can be confusing when dealing with negative numbers: it could be interpreted as 'increase' to a higher number (say from -90 to -100 where 100 is higher than 90) or as an 'increase' to a less negative number (say from -90 to -80). I think better wording would be to rewrite this sentence as: "Increased extracellular potassium levels result in depolarization of the membrane potentials of cells due to the equilibrium potential of potassium becoming less negative."

Thoughts?

What about calculating TTKG to aid in the differential diagnosis?

What about calculating TTKG to aid in the differential diagnosis? Cybergoth 12:18, 27 August 2005 (UTC)

Put it in. alteripse 21:34, 27 August 2005 (UTC)

Yes, that would be useful. Here is an online calculator. JFW | T@lk 23:08, 27 August 2005 (UTC)

I made a TTKG stub. Cybergoth 04:09, 2 September 2005 (UTC)

Deleted "Liddles Syndrome" & "Pseudohyperaldosteronism" from the Differential Diagnosis, since those are associated with HYPOkalemia. 129.22.127.147 02:51, 10 March 2006

Good pick up. Andrew73 13:19, 10 March 2006 (UTC)

I like that "lethal injection" is listed under "causes include:" :-) Mbarbier 17:48, 8 November 2007 (UTC)

I agree that its very wierd (and funny) to have "lethal injection" there. But really, its probably the best place for it, rather than creating a separate section for it. :-) Dan Levy 19:40, 8 November 2007 (UTC)

hyperkalemia wrong information in article

Increased extracellular potassium will cause hyperpolarization and not depolarization of the cell membrane. dont you agree?

Disagree: Imagine a typical cell which has a membrane voltage determined predominately by conductance through potassium channels. The point of equilibrium (where the membrane potential will equilibrate) is the Nernst potential for K, which equals -60mV*Log([K]i/[K]o). As [K]o rises, the membrane will equilibrate at a less negative potential. Hence, the cell will be depolarized in the setting of hyperkalemia. DanLevy 04:53, 10 June 2006 (UTC)

+

Will delete comment by user 85.167.25.246 regarding Hyperkalemia causing acidosis. True that cardiac arrest, or weakness of diaphragmatic muscles could lead to hypoxia/ischemia that would cause acidosis, but I think that these would be extreme examples, and the statement is otherwise misleading. Dan Levy 03:26, 12 December 2006 (UTC)

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Jan 11th, 2007

Changed the phrase: Potassium is the most important intracellular cation and participates in many cellular processes to Potassium is an important intracellular cation and participates in many cellular processes.

I don't think you can establish that K+ is the most important intracellular cation, considering the important of Na+ and Ca2+.

......JFW has reverted the sentence, but I agree with the above author....Is the heart or the brain the most important organ? Without intracellular calcium, none of our cells would work either. Abundance is irrelevant. How about we settle on "a critically important cation."Dan Levy 02:52, 12 January 2007 (UTC)

Pseudohyperkalemia

I deleted the phrase: "It can be avoided by using plasma from anticoagulated blood samples, as this will reduce the destruction of cells and platelets during the clotting process." because I think that it was misleading. It was located right after mentioning the familial pseudohyperkalemias. In fact, in ref 3 (Blood, 1999) the heparinized blood that incubates for a few hrs shows increased serum [K] over time. But I think that the statement might apply for thrombocytosis and perhaps it should simply be moved to a different position in the paragraph? I assume that the best strategy for any suspected case of pseudohyperkalemia would be to spin anticoagulated blood immediately and measure the K from the plasma. I know that plasma K is always a bit lower than serum K, but would user 205.160.195.36 be able to offer a reference that anticoagulation would specifically be helpful when pseudohyperkalemia is suspected? Dan Levy 22:59, 19 June 2007 (UTC)

I think you are correct to have removed it, but would defer to an explicit reference. alteripse 00:04, 20 June 2007 (UTC)

Execution

Since the death penalty is contrary to international law and human rights as generally understood, I find it inappropriate to mention its methodology in the context of an article on a medical subject. I would urge the deletion of the relevant paragraph.83.65.178.206 (talk) 10:37, 30 October 2008 (UTC)

Interesting point. Is it really against international law? Lethal injection is the primary method of execution performed in the USA, which was evidently performed 42 times in the US in 2007. I wouldn't want to defend my nation's moral/legal system, but I would point out that the mechanism of death from this technique is the same as death from any other cause of hyperkalemia. So even though physicians are not involved in executions, the section is related to the physiological/pathophysiological condition of hyperkalemia. Would it be more palatable if the other details of execution were removed, perhaps by deleting thie latter half of the sentence? ("after sodium thiopental has rendered the subject unconscious, then pancuronium bromide has been added to cause paralysis.") Dan Levy (talk) 22:05, 30 October 2008 (UTC)

Since the death penalty is still quite real in many countries, including germane information that raises its salience as an issue can lead to a better-informed debate, the foundation for policy re-considerations in those countries where it is still practiced. Knowledge and daylight better foster changes in the marketplace of ideas than ignorance. —Preceding unsigned comment added by 66.167.61.132 (talk) 22:43, 16 April 2009 (UTC)

Acute Treatment versus Prevention

I agree with user user:Mikael Häggström that it makes more sense to split the TREATMENT section into acute mgmt and prevention. But I'm not sure what should be done with Kayexalate. In some patients, it is used chronically to reduce the risk of a hyperkalemic episode, but it also used to remove K from the body in a patient with a mild-to-mod hyperkalemia, such as in the 5.5-6.2 mEq/L range, in a patient who might not otherwise need dialysis. So wouldn't this *also* be acute treatment? Suggestions, anyone? Dan Levy (talk) 14:59, 6 January 2009 (UTC).

Tomato paste as a source

Tomato paste is the most-concentrated dietary source of potassium. —Preceding unsigned comment added by 66.167.61.132 (talk) 22:39, 16 April 2009 (UTC)

How much exactly?

What would be "massive doses of oral KCl supplements", also in terms of tomato paste (twice concentrated)? --Ayacop (talk) 18:10, 1 June 2009 (UTC)

Exactly. I came to this article to find out how much potassium is too much, and went away unsatisfied. Correctrix (talk) 03:19, 12 August 2015 (UTC)

We do not give med doses here typically. Doc James (talk · contribs · email) 06:51, 12 August 2015 (UTC)

Review

Elliott MJ, Ronksley PE, Clase CM, Ahmed SB, Hemmelgarn BR (2010). "Management of patients with acute hyperkalemia". CMAJ. 182 (15): 1631–5. doi:10.1503/cmaj.100461. PMID 20855477. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) Doc James (talk · contribs · email) 20:51, 28 November 2010 (UTC)

PMC 1972434 seems very practical. JFW | T@lk 21:07, 17 May 2011 (UTC)

doi:10.1097/CCM.0b013e31818f222b is good, and gives NNT for many treatments (e.g. NNT for salbutamol is 3!) JFW | T@lk 22:20, 22 October 2011 (UTC)

More sources

doi:10.1002/14651858.CD003235.pub2 - Cochrane review of emergency treatment.

doi:10.1136/bmj.b4114 - BMJ review 2009. JFW | T@lk 14:38, 21 September 2012 (UTC)

Am J Med 2015: doi:10.1016/j.amjmed.2015.05.040 JFW | T@lk 20:07, 21 November 2015 (UTC)

Resources

The following resources may be useful in enriching this article:

• Cakir, M. (2010). "Significant hyperkalemia and hyponatremia secondary to telmisartan/hydrochlorothiazide treatment". Blood Press. 19 (6): 380–2. doi:10.3109/08037051.2010.488056. PMID 20486869. {{cite journal}}: Unknown parameter |month= ignored (help)
• Peddle, M (2008 May). "Case 2: Hyponatremia and hyperkalemia in a four-week-old boy". Paediatric & child health. 13 (5): 387–90. PMC 2532890. PMID 19412367. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Hyponatremia and hyperkalemia By Norbert Lameire
• Emergency lectures - Hyponatremia hyperkalemia

Diptanshu^Talk 14:09, 24 June 2013 (UTC)

None of those are great WP:MEDRS sources.... JFW | T@lk 11:48, 19 January 2014 (UTC)

• "Hyponatremia and hyperkalemia By Norbert Lameire" has been moved to http://www.theisn.org/education-by-topic/fluids-ahyponatremia-and-hyperkalemia-dp2. 220 of ^Borg 03:48, 2 March 2014 (UTC)

Priorities for updating

WP:MEDRS-compatible sources are available (I've posted a few above over the last few months) but we're not using them... JFW | T@lk 11:51, 19 January 2014 (UTC)

doi:10.1016/j.kint.2015 seems nice. JFW | T@lk 11:23, 22 February 2016 (UTC)

what's the connection?

I don't see the connection of this sentence to Hyperkalemia. Assuming that there is one, perhaps someone could make it more obvious?

"The combination of abdominal pain, hypoglycemia, and hyperpigmentation—often in the context of other autoimmune disorders—may indicate Addison's disease,[12] which is a medical emergency."

Rick.Wicks (talk) 10:21, 4 October 2016 (UTC)

Addison's disease can cause mineralocorticoid deficiency (insufficient aldosterone) which can definitely cause hyperkalaemia. Still, the symptoms can be different from listed here. JFW | T@lk 20:18, 5 October 2016 (UTC)

Popular untested cures.

Social media has been promoting cream of tartar, a cooking ingredient with the chemical name potassium bitartrate as a cure for several things including Migraines, losing weight etc. "Ingesting extremely high quantities of the chemical is not advisable as it can result in life-threatening cases of hyperkalemia, which is the abnormally high concentration of potassium in the blood."

To keep his brief I just quote Snopes - probably not good enough reference for here - but it mentions the current obsession. I leave to others to consider... https://www.snopes.com/fact-check/cream-of-tartar-migraine-headaches/ 60.242.247.177 (talk) 21:11, 19 December 2018 (UTC)

I have only found a single case report: doi:10.1007/s13181-012-0255-x. Probably not heavy enough for inclusion. People with healthy guts and kidneys can handle pretty large amounts of potassium. JFW | T@lk 20:24, 22 December 2018 (UTC)

Fast acting insulin and glucose

I understand fast acting insulin (Novorapid to be precise) is used to treat acute hyperkalemia. Especially in a clinical setting where the cause is due to surgery or other treatment. The patient is given an IV solution of Novorapid with glucose (the avoid hypoglycemia due to the extra insulin). This is done mainly where blood- or other fluid losses- are the cause of the hyperkalemia, not when there is a systemic problem. Should these two things be included in the article? Fast acting insulin as a treatment and blood cq fluid loss as a cause?

Korporaal1 (talk) 17:35, 10 January 2021 (UTC)

Wiki Education assignment: PHMD 2040 Service-Learning

This article was the subject of a Wiki Education Foundation-supported course assignment, between 19 October 2021 and 31 May 2022. Further details are available on the course page. Student editor(s): BChinphmd (article contribs).