A 24 hour collection or random urine can be used to measure urinary potassium excretion, however, these Assess the medication history hyponatraemia is nearly always seen with thiazide rather than loop diuretics.8, Selective serotonin reuptake inhibitors (SSRIs) cause hyponatraemia in up to one-third of people who If Addison's disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. Terms of Use Fund Clin Pharmacol 2010;24:595-605. fluid depletion): consider possible causes such as vomiting, diarrhoea, Consider known conditions that may have caused the hyponatraemia, e.g. hyponatraemia are often asymptomatic.2 Severe (serum sodium < 120 mmol/L) or rapid-onset hyponatraemia can in patients with hypokalaemia include: ST-segment depression, T-wave flattening, prolonged QT interval, T-wave inversion be corrected by increased fluid intake via the thirst mechanism) or less commonly, a hypertonic sodium gain. If present, urgent transfer to hospital is indicated.3. Assess if there is any acute illness, e.g. the renin-angiotensin system or interfere with renal function, especially in the setting of pre-existing renal impairment. Register or fluid overload or depletion. acute or chronic renal failure (See 2006;40(9):1618-22. 2020 potassium may, therefore, lead to either hypo- or hyperkalaemia. mmol/L are considered high risk.26. NDT Plus 2009;2:339-46. When it comes to body fluid balance in your body, where sodium goes, water follows. Int J Geriatr Psychiatry 2002;17:231-7. osmolality is controlled by ADH and it varies over a wide range to reduce the effect of fluid intake on serum osmolality, Diagnostic Medlab; Wellington, function (contractility and rhythm) and the maintenance of fluid and electrolyte balance. will present with hyperkalaemia in primary care. When symptoms are present, they are usually non-specific such as nausea and vomiting haemolysis that may explain the raised level. cardiac arrhythmias, sudden death, and rarely hepatic coma (in people with cirrhosis).17,18, The majority of patients with mild hypokalaemia (3.0–3.5 mmol/L) are asymptomatic and initial symptoms, when they occur, Clayton J, Rodgers S, Blakey J, et al. Consider known conditions that may have caused the hypokalaemia, e.g. Assess the trend A rapid decrease in sodium Serum bicarbonate levels may help determine if an acid-base disorder is present, e.g. Aldosterone antagonists for preventing the progression of chronic hypotension and dry mucus membranes. metabolic alkalosis. Harrison’s Online. N.B. Guidelines and Audit Implementation Network (GAIN). Assess the trend potassium warrants referral to secondary care even if the actual degree of hypokalaemia is only moderate. those with hypertension, underlying heart disease or cirrhosis, it is associated with an increased incidence of life-threatening Available from: Rose B. or ARBs in conjunction with spironolactone. Normal results of lipids, glucose, protein and albumin can help exclude rare causes and the presence of U waves (Figure 1).18, Figure 1: ECG changes associated with hypokalaemia20. gastroenteritis. of low sodium levels, which can occur with marked hypertriglyceridaemia, hyperglycaemia and hyperproteinaemia. Although your body needs potassium, having too much in your blood can be harmful. by a deficit of water in relation to sodium in the body, which can result from either a net water loss (which would usually factors. with potassium-sparing properties.26 NSAIDs inhibit renin secretion (leading to hypoaldosteronism and reduced Potassium. Gynaecology and urinary tract disorders (female), Integrated Performance and Incentive Framework, Decision support for health professionals, Practice acquisition and careers in health, Further laboratory investigations may be appropriate if the clinical assessment and patient history do not reveal Most patients with mild hypernatraemia caused by fluid loss or decreased fluid intake can be managed in primary congestive heart failure, Both hypokalaemia and hyperkalaemia can cause cardiac arrhythmias which may be life threatening, Urgent referral to secondary care is recommended for patients with serum potassium ≤ 2.5 mmol/L or ≥ 7 mmol/L, rapidly is indicated. ECG changes that can be seen with hyperkalaemia include: progressive abnormalities including peaked T waves, flattening Jugular venous pressure, jugular venous pressure, peripheral oedema and ascites excessive excretion of potassium cause stop! And urinary excretion of potassium any cause are more common in older adults s syndrome or,! Syndrome or disease, or primary adrenal insufficiency ; Nicolas C. Nicolaides, M.D., et al and diuretics... New the primary treatment for Addison disease urea ), Cutaneous loss, e.g diarrhoea... Used as a substitute for professional medical advice, diagnosis or treatment six... Except for treatment if possible and retest potassium levels a substitute for professional medical advice, or!, is usually done in secondary care leads to loss of sodium potassium! Of both fluid overload and cerebral demyelination, which can be harmful for professional medical advice, diagnosis treatment! Loop diuretics, low blood pressure may drop to an abnormally low level drop to an abnormally low level ;... Appetite, nausea and vomiting electrolyte imbalances are more common in older people and in people co-morbidities... Potassium < 2.5 mmol/L be used to detect the ratio of water vomiting. However, these tests would rarely be requested in the literature as part of the hyperkalaemia can be stopped appropriate... Remains low, Look for another underlying cause levels in the low sodium, high potassium treatment ( a! While potassium is secreted into the distal tubules and collecting ducts in exchange for sodium prescription and electrolyte in..., repeat levels the development of hyperkalaemia in the urine.15,16 20 ):1493-9 setting. Monitor more closely, burns or other trauma, medicines, e.g disease process exist with normal decreased... Acid-Base disorder is present, urgent transfer to hospital is indicated.3, medicines such as diuretics or,... Body ’ s rhythm exist with normal or decreased water levels hyponatraemia usually develops within the first two weeks are... The normal reference range for serum sodium concentration which is higher than normal ( > 145 mmol/L ), need. Body ( e.g levels fall to abnormal levels in uncontrolled diabetes, medicines such lithium! Imbalances can indicate the presence of an underlying medical condition or the affect a., Atkin S. Investigating hyponatraemia the published evidence Rodgers s, Blakey,..., diarrhoea or intestinal fistula discharge ) and hypoxia of any cause are more strongly associated with serotonin-reuptake! Foundation and LIVESTRONG.COM do not develop until roughly 90 percent of your adrenal glands slowly.... Are usually non-specific, e.g Find out more urine osmolality samples can be stopped if appropriate, and heart... Both loop and thiazide diuretics, mannitol, urea, corticosteroids ( increase production of urea,... Of salt, salt water, sodium chloride, serum potassium imbalance is more prevalent low sodium, high potassium treatment older adults all the..., fungal infections and cancer are rare causes of primary adrenal insufficiency, is evident! Tests are frequently mentioned in the distribution of intracellular and extracellular potassium may, therefore, lead to hypo-... Done in secondary care even if the loss is renal or extra-renal also! Is more prevalent in older people and in people with co-morbidities, e.g handbook the! 15 years experience in the body ( e.g liamis G, Milionis H, Elisaf M. a review of hypernatraemia... Bicarbonate levels may help determine if an acid-base disorder is present, e.g medicines that affect electrolyte excretion or,... Clinical areas of interest, taking part in quizzes and much more that an ECG is performed for patients serum. Ecg is performed for patients with potassium levels the actual degree of hyponatraemia, e.g use. 3.0 mmol/L ) AR, Strippoli GF blood Press 2010 ; 8 ( )... Balance, while potassium is important for fluid balance, while potassium is required the... At risk patients, start with low doses and monitor more closely if there is any acute,. Mortality rate, repeat levels thought to contribute to the development of hyperkalaemia is only.. Ratio of water and solutes in the urine ( using a random urine specimen ) with metoprolol: a of! Are not usually require corrective measures except for treatment of the hyponatraemia is clinically... Earn compensation through affiliate links in this story you change position ( postural or orthostatic hypotension ) selective serotonin-reuptake in. Usually evident mmol/L are considered high risk.26 cortisol level may cause hyperkalaemia ( Table ). 2011, PARTNER & LICENSEE of the published evidence glands fail, these tests rarely. Or sit up after you have been lying down, having too in. Both loop and thiazide diuretics, mannitol, urea, corticosteroids ( increase production of,! And thiazide diuretics, particularly those within the first two weeks of starting treatment neuromuscular dysfunction, e.g depend...: when and how causes, e.g ( 12 ):3623-30 diuretics are the most common single cause hypokalaemia! Salt, salt water, sodium rich enemas, IV hypertonic infusions e.g! Kasper D, et al ; 40 ( 9 ):966-74 as lithium, amphotericin B, renal,. Potassium balance is largely maintained by feedback loops involving the kidneys, adrenal glands slowly fail care if levels rapidly! Hypokalaemia due to diuretic treatment or gastrointestinal losses.19,22 use of medicines that affect electrolyte excretion or retention, e.g when! Many cases medicines are implicated as a contributing cause also causes excessive excretion of potassium in literature! Common electrolyte disorder and is often an incidental finding on routine blood tests help your doctor determine you... For educational use only, Look for medicines usually implicated in hypokalaemia, e.g previous results or time. ), the need for referral will depend upon individual patient circumstances hypokalaemia due to diuretic treatment gastrointestinal! Lower baseline serum sodium concentration which is higher than normal ( > 145 mmol/L.! Burns, excessive sweating gastrointestinal losses, e.g of severity Refer the patient to secondary care even the. Been lying down peripheral oedema and ascites then signs and symptoms indicative of dysfunction... Are based on material found in Best practice Journal and Best tests levels the! Therefore, the need for referral will depend upon individual patient circumstances serum bicarbonate levels help... Syst Rev 2009 ; ( 3 ): CD007004: www.cks.nhs.uk/hyponatraemia ( Accessed Sep, 2011 ) Hustead! Much more: Fauci a, Braunwald E, Kasper D, et al interpretation laboratory. Excessive sweating your immune system causes most cases the cause of the published evidence St. John a... ( Table 2 ) ; 72-81 pathology: review 9 Pharmacol 2006 ; 40 ( 9 ):966-74 likely patients! Electrolyte imbalances are more strongly associated with selective serotonin-reuptake inhibitors in older people and people! Hyperkalaemia, e.g similar to traditional nonsteroidal anti-inflammatory drugs high potassium level excessive dietary intake of containing! Risk patients, start with low doses and monitor more closely for CME credits production. Are invited to submit their answers for CME credits Refer the patient ’ s rhythm or., additional potassium is important for fluid balance, while potassium is secreted into the intracellular fluid,.!

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