What is Hyperkalemia?

It is a condition in which the levels of Potassium in the blood increase above the normal levels. Clinically it is defined as plasma potassium levels >5mEq/L.

Understanding Hyperkalemia

Potassium is a positively charged ion present in the body as a major intracellular (inside the cells) ion. Its concentration in the plasma is very small compared to its concentration inside the cells. So, even a small change in the plasma reflects as a huge change in the concentration in terms of percentage, and therefore even small fluctuations can have life-threatening consequences.

Potassium may be elevated due to excessive intake or reduced excretion. As the concentration of the ion increases in the plasma, the concentration gradient reduces and the potassium inside the cells tends to stay inside the cells. As the cells keep accumulating a positively charged ion, they become more positively charged (relatively), which finally boils down to the fact that they become very easily excitable.

This change is relatively unapparent in most of the cells but is significant in brain cells and muscle cells, especially in the heart muscle.

Unlike Hypokalemia, in which symptoms develop gradually, Hyperkalemia can precipitate sudden disastrous symptoms which may also lead to sudden death due to cardiac arrest, especially so in an elderly patient whose body systems are already worn out by age.

What are the symptoms of Hyperkalemia?

Symptoms of Hyperkalemia are mainly cardiac symptoms. Changes seen on ECG are:

  1. Tall peaked T waves
  2. Prolonged PR interval
  3. Complete Heart block
  4. Reduced heart rate
  5. Wide QRS complex
  6. Ventricular fibrillation and cardiac arrest

What are the risk factors for Hyperkalemia?

Potassium is a delicately controlled electrolyte whose control rests with the kidney. Elderly with aging systems, particularly an aged kidney and/or a patient taking a drug that affect the kidney, are more prone to developing this imbalance.

Elderly patients also tend to take some kind of pain medication. A very popular class is NSAIDs (non-steroidal anti–inflammatory agents). These drugs damage the kidney and can cause potassium imbalance after prolonged use.

What are the causes of Hyperkalemia?

Most common cause by far in the elderly is kidney disease.

1. Increased intake of potassium

2. Tissue breakdown

    • Haemolysis
    • Bleeding into tissues

3. Shifting out of potassium from inside the cells to the outside

    • Acidosis
    • Insulin deficiency
    • Aldosterone deficiency

4. Impaired renal function

    • Acute kidney shutdown
    • Severe chronic kidney failure
    • Patient on NSAIDs (a class of pain killers)

What are the complications with Hyperkalemia?

Hyperkalemia causes severe life-threatening arrhythmias (disorders of the rhythm of the heart), and this is most often the cause of death in these patients.

How is Hyperkalemia diagnosed?

Generally, if the history of the patient is suggestive, ECG is quite diagnostic of Hyperkalemia. However, in an elderly patient, the physician would also asses the following:

  1. Levels of sodium
  2. Levels of creatinine and urea to assess the state of the kidney
  3. Blood glucose levels
  4. Estimation of blood pH

What is the treatment for Hyperkalemia?

  1. Identification of the cause of Hyperkalemia and its appropriate treatment.
  2. Use of diuretics with saline infusions to remove potassium.
  3. Administration of glucose with insulin. (potassium is driven into the cells by insulin for the utilisation of glucose)
  4. Correction of metabolic acidosis by the use of sodium bicarbonate.
  5. If everything fails, the patient is taken for dialysis.

Diet and Rehabilitation

Reduction in dietary potassium is the mainstay of treatment. The patients are advised to cut down on any over the counter medication they are taking, especially pain killers.

How can Hyperkalemia be prevented?

Hyperkalemia in elderly can be prevented by sticking to the diet regimens as advised by the physician and avoiding any kind of self medications however trivial or insignificant the complaint may seem.

Regular monitoring of kidney function is advisable for any elderly individual taking any chronic medication.

Consuming adequate volumes of water may go a along way in preventing electrolyte disturbances in elderly. Sometimes simple things get overlooked while planning long term treatments in elderly, who are essentially dependant on their caregivers.

Also Read: All About Hypokalemia

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