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POTASSIUM-HYPERKALEMIA CAUSES

Nephrology

POTASSIUM-HYPERKALEMIA CAUSES

1. Decreased renin: dysfunctional kidneys that do not release renin ("hyporeninemic hypoaldosteronism"); chronic interstitial nephritis; diabetes; exacerbated by NSAIDs

2. Decreased aldosterone:
- Potassium-sparing diuretics (Spironolactone blocks the aldosterone receptor; amiloride blocks the channel its action depends on)
- ACE inhibitors, angiotensin receptor antagonists, and renin inhibition
- Primary adrenal disease (Addison's), because it affects both the zona glomerulosa (site of aldosterone production) and fasciculata (site of cortisol production) - but not secondary adrenal insufficiency because lack of ACTH affects only the zona fasciculata
-
Heparins (Both unfractionated and low molecular weight are directly toxic to the zona glomerulosa)

3. Cellular shift: metabolic acidosis (K + /H + exchange), increased cell turnover (tumor lysis syndrome, rhabdomyolysis, acute leukemia)

4. Renal accumulation: Type 4 RTA

5. Drugs: Trimethoprim in TMP/SMX interferes with K + secretion in the late distal tubule and cortical collecting duct


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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