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Hyperkalemia is a condition of elevated serum potassium concentration due to increased potassium release from cells, excess potassium intake, or more commonly, reduced excretion of urinary potassium. May be caused by excessive load (administration or intake of potassium) – such as with potassium salts, blood transfusions (not fresh), or extreme intake of water treated with potassium-based water softener – impaired excretion as seen in renal failure, or use of potassium-sparing diuretic drugs, NSAIDs, ACE inhibitors, aldosterone-suppressing therapies, or other drug-induced effects (such as digitalis toxicity). Other causes include Addison disease, decreased insulin with high osmolality, acidosis (eg, diabetic ketoacidosis), dehydration, hyperventilation, pregnancy, and malignant hyperthermia.

Signs and symptoms include muscle weakness, paralysis, hypothermia, and cardiac abnormalities (irregular conduction and arrhythmias).

EKG changes of hyperkalemia generally correlate with potassium levels.

With mild elevation (5.5-6.5), the EKG is notable for peaked T waves, shortened QT interval, and ST segment depression.

At higher levels of potassium (<88.0), the EKG demonstrates peaked T waves, PR prolongation with decreased P waves, and widening QRS. At potassium levels >8.0, P waves are lost, the QRS progressively widens, and intravesicular / fascicular / bundle branch blocks develop, progressing to sine wave pattern followed by ventricular fibrillation or asystole.

Pseudohyperkalemia can be caused by improper blood drawing techniques, hemolysis, tourniquet use, and clenched fists.

In addition to acquired hyperkalemia, hyperkalemic periodic paralysis is an autosomal dominant inherited disorder that causes fluctuating potassium levels and episodic muscle weakness when potassium levels are high.


E87.5 – Hyperkalemia

14140009 – Hyperkalemia

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated: 02/14/2018
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Hyperkalemia : Fatigue, Nausea, Flaccid paralysis, Hyperkalemia, Muscle weakness, Heart palpitations, Cardiac dysrhythmia, Paresthesias
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