Hyperkalemia Side Effect
Potassium is an essential mineral micronutrient and an important electrolyte required for physiological functioning. Hyperkalemia is a medical condition in which a serum potassium concentration is greater than 5.0 mmol/L.
Abnormally high potassium levels can cause severe cardiac electrophysiology alterations, such as cardiac arrhythmias. Severe hyperkalemia (potassium >6.5 mmol/L) is potentially life-threatening condition.
Generally, hyperkalemia may be caused by the following mechanisms17:
- excessive potassium intake
- disturbed cellular uptake of potassium
- impaired renal excretion of potassium
The impairment of renal potassium excretion due to inhibition of the renin-angiotensin-aldosterone system is the most common mechanism by which medications cause hyperkalemia. Certain medications may also increase potassium supply. Drug-drug interactions that result in increased potassium levels are also common.
Medicines affecting the renin-angiotensin system are the most common cause of hyperkalaemia. List of drugs that may cause Hyperkalemia as a side effect:
|Diminishes potassium secretion by reducing the electrical gradient between the intracellular space and the renal tubule|
Epsilon-aminocaproic acid (Amicar)
|Cationic amino acids enter cells in exchange for potassium, causing hyperkalemia1|
|Angiotensin Receptor Blockers (ARB)2||10-30%, ARBs reduce renal potassium excretion via decreased aldosterone synthesis. ARBs may be more likely to cause hyperkalemia than ACE inhibitors3|
|Angiotensin-Converting Enzyme Inhibitors (ACEi)2, 3||up to 20.4%|
Decrease sodium-potassium adenosine triphosphatase activity
|Cyclosporine (Sandimmune)4||Suppresses renin release, leading to decreased aldosterone synthesis|
|Digoxin at toxic levels8||Extremely high serum concentrations of digixin produce hyperkalemia|
|Fluoride toxicity9||Most common in patients on dialysis who drink water with high fluoride levels|
|Glucose infusions||Hypertonicity caused by hyperglycemia from glucose infusions can drive potassium out of the intracellular space.leading to hyperkalemia. Hyperkalemia may occur with continuous infusions or with boluses of hypertonic glucose. May be present with hypertonicity caused by other agents such as mannitol Osmitrol|
|Heparins10||Inhibit adrenal aldosterone production+Can cause hyperkalemia in patients with decreased renal function|
|NSAIDs11||Decreased renal prostaglandin synthesis leads to decreased afferent arteriolar flow, suppressing renin and aldosterone secretion. The strongest risk factors for NSAID-induced hyperkalemia include prior episode of hyperkalemia, Chronic kidney disease, diabetes, and use of potassium-sparing diuretics 12|
|Penicillin G potassium13||Can cause hyperkalemia in patients with impaired renal function caused by increased potassium load|
|Potassium-sparing diuretics||Blockade of luminal sodium channels. Hyperkalemia is a main complication of the potassium-sparing diuretics|
|Consumption of potassium can lead to hyperkalemia, particularly if renal function is impaired|
|Spironolactone (Aldactone)||The risk is higher when spironolactone is used concomitantly with ACE inhibitors14|
|Succinylcholine (Anectine)15||Increases nicotinic acetylcholine receptors in damaged skeletal muscles e.g. thermal trauma|
|Tacrolimus (Prograf)||Causes hyperkalemia by various mechanisms affecting potassium in the distal tubule16|
Pentamidine (Pentam 300)19
|Decreases renal potassium excretion through the competitive inhibition of epithelial sodium channels in the distal nephron|
Risk factors for drug-induced hyperkalemia:
- chronic renal insufficiency
- renal disease
- increasing age
- metabolic acidosis
- diabetes mellitus, insulin deficiency
- increased potassium intake
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Published: January 17, 2017
Last updated: February 10, 2017