How and when should patients with hyperkalemia (high serum potassium level) be monitored?

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

For patients whose hyperkalemia resulted from a single, clearly defined episode (eg, acute exertional rhabdomyolysis or drug-induced hemolysis), infrequent monitoring of serum potassium generally suffices. However, for patients who have conditions or medications that will continue to predispose to hyperkalemia, more frequent monitoring of serum potassium is required. For patients at high risk, monthly measurements are indicated.

Continuing care relates to the disease process that led to the hyperkalemia. For patients who have recurrent or constant hyperkalemia (eg, those with diabetic nephropathy and type IV renal tubular acidosis), long-term therapy with an oral loop diuretic and SPS may be indicated. For pseudohypoaldosteronism type II, the treatment of choice is a thiazide diuretic.

The risk of severe hypoglycemia for patients with acute kidney injury or end-stage renal disease is heightened in patients with lower body weight and creatinine clearance. Sufficient dextrose in the patient’s treatment regimen can minimize the risk. [77] In patients with salt-wasting congenital adrenal hyperplasia, corticosteroid and mineralocorticoid supplementation are necessary.


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