Extreme hyperkalemia.To the Editor: Hyporeninemic hypoaldosteronism was one of the postulated mechanisms mediating hyperkalemia Hyperkalemia Definition The normal concentration of potassium in the serum is in the range of 3.5 to 5.0 mM. Hyperkalemia refers to serum or plasma levels of potassium ions above 5.0 mM. in the case report by Dr. H. A. Tran published in the July 2005 issue of the Southern Medical Journal. (1) I would add that emergency treatment of intractable hyperkalemia should include not only routine measures such as calcium gluconate and insulin and glucose infusion, as mentioned by the author, but also intravenous sodium bicarbonate and [beta]-adrenergic agonists, the latter parenterally or by nebulization nebulization /neb·u·li·za·tion/ (neb?u-li-za´shun) 1. conversion into an aerosol or spray. 2. treatment by an aerosol. . (2) There may also be a place for empiric treatment with parenteral hydrocortisone hydrocortisone (hī'drəkôr`tĭzōn'), another name for the steroid hormone cortisol, more especially used to refer to preparations of this hormone used medicinally. when the biochemical profile is compatible with hyporeninemic hypoaldosteronism and risk factors for this condition are present. This was the case in a patient who was being treated with the heparin analogue pentosan polysulfate in the presence of nephrocalcinosis and in whom hyperkalemia remained refractory, not only to intravenous calcium gluconate, insulin, and glucose, but also to the cation exchange resin calcium resonium. Only on the fourteenth day, when she was coprescribed intravenous hydrocortisone, sodium bicarbonate infusion, and nebulized albuterol, did her plasma potassium fall from 7.2 mmol/L to 3.4 mmol/L. (3) Arguably, the therapeutic contribution of hydrocortisone was attributable to its mineralocorticoid mineralocorticoid /min·er·alo·cor·ti·coid/ (min?er-il-o-kor´ti-koid) 1. any of the group of corticosteroids, principally aldosterone, primarily involved in the regulation of electrolyte and water balance through their effect on action, given the fact that mineralocorticoids mineralocorticoids (min´  ral´ōkôr´tikoidz),n. ameliorate hyperkalemia in hyporeninemic hypoaldosteronism. (4,5) O. M. P. Jolobe, MRCP MRCP Member of Royal College of Physicians. MRCP abbr. Member of the Royal College of Physicians Manchester Medical Society Manchester, United Kingdom References 1. Tran HA. Extreme hyperkalemia. South Med J 2005;98:729-732. 2. Singer GS, Brenner BM. Fluid and electrolyte disturbances. In Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL (eds): Harrison's Principles of Internal Medicine Harrison's Principles of Internal Medicine is an American textbook of internal medicine. First published in 1950, it is presently in its sixteenth edition. Although it is aimed at all members of the medical profession, it is mainly used by internists and junior doctors in Chapter 49, 14th ed, McGraw-Hill Health Profession Division, New York, 1998. 3. Jolobe OMP. Hyperkalaemic paralysis (letter). Age Ageing 2003;32:556-557. 4. Orth DN, Kovacs WJ. The Adrenal Cortex. In Wilson JD. Foster DW, Kronenberg HM, Larsen PR (eds): Williams Textbook of Endocrinology, 9th ed, WB Saunders Co, Philadelphia, 1998. 5. De Fronzo RA. Hyperkalemia and hyporeninemic hypoaldosteronism. Kidney Int 1980;17:118-134. |
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