What causes potassium to shift from the intracellular to the extracellular space?

Updated: Jun 20, 2018
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

A number of factors can influence the shift of potassium from the intracellular to the extracellular space (see table below). By itself, this mechanism is a relatively uncommon cause of hyperkalemia, but it can exacerbate hyperkalemia produced by high intake or impaired renal excretion of potassium. A common scenario is that insulin deficiency or acute acidosis produces mild-to-moderate impairment of intracellular shifting of potassium.

Table. Selected Factors Affecting Plasma Potassium (Open Table in a new window)

Factor

Effect on Plasma K+

Mechanism

Aldosterone

Decrease

Increases sodium resorption, and increases K+ excretion

Insulin

Decrease

Stimulates K+ entry into cells by increasing sodium efflux (energy-dependent process)

Beta-adrenergic agents

Decrease

Increases skeletal muscle uptake of K+

Alpha-adrenergic agents

Increase

Impairs cellular K+ uptake

Acidosis (decreased pH)

Increase

Impairs cellular K+ uptake

Alkalosis (increased pH)

Decrease

Enhances cellular K+ uptake

Cell damage

Increase

Intracellular K+ release

Succinylcholine

Increase

Cell membrane depolarization


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