Content continues after advertisement

Differential Diagnosis: Hyperkalemia

Julie Allen, BVMS, MS, MRCVS, DACVIM (SAIM), DACVP, Cornell University

Internal Medicine

|November 2019|Peer Reviewed

Sign in to Print/View PDF

Differential Diagnosis: Hyperkalemia

Following are differential diagnoses, listed in order of likelihood,* for patients presented with hyperkalemia.

  • Pseudohyperkalemia
    • Potassium EDTA contamination
    • Hemolysis (in vitro or in vivo) or RBC leakage in certain Asian breeds that have high-potassium erythrocytes (eg, Shiba Inu) or any breed with marked reticulocytosis
    • Thrombocytosis and, possibly, marked leukocytosis (eg, leukemia)
    • Contamination with high-potassium fluids due to collection from improperly flushed IV line
  • Urethral (or, less likely, bilateral ureteral) obstruction
  • Acute kidney injury (oliguric/anuric)
  • End-stage kidney disease (oliguric/anuric) 
  • Uroabdomen
  • Hypoadrenocorticism
  • Chronic kidney disease
  • Drug-induced/iatrogenic cause; usually only in combination with other issues (eg, decreased renal function). May decrease renal excretion and/or affect transcellular movement
    • ACE inhibitors (eg, enalapril)
    • Aldosterone antagonists (eg, spironolactone)
    • Angiotensin II-receptor blockers (eg, telmisartan) 
    • NSAIDs
    • Cyclosporine or tacrolimus
    • Trimethoprim/sulfonamides (trimethoprim decreases potassium excretion in the distal renal tubule) 
    • Trilostane
    • Mitotane
    • Heparin
    • Total parenteral nutrition
    • Digoxin
    • β blockers
  • Metabolic (rarely respiratory) acidosis
  • Insulin deficiency
  • Massive tissue damage (eg, rhabdomyolysis, reperfusion injury after thromboembolic event, gastric torsion)
  • Trichuris vulpis infection 
  • Severe malabsorption
  • Salmonellosis
  • Perforated duodenal ulcer 
  • Chylous effusions following drainage
  • Peritoneal effusion (cats)
  • Hyporeninemic hypoaldosteronism 
  • Late pregnancy (greyhounds) 
  • Acute tumor lysis syndrome
  • Strenuous exercise 
  • Hyperkalemic periodic paralysis
  • Increased intake
    • Excessive potassium supplementation in IV fluids
    • High-dose potassium penicillin

*Order of likelihood is based on the author’s personal experience.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

Podcasts

Clinician's Brief:
The Podcast

Listen as host Beckie Mossor, RVT, talks with the authors of your favorite Clinician’s Brief articles. Dig deeper and explore the conversations behind the content here.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*

*2007-2017 PERQ and Essential Media Studies

© 2018 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Privacy Policy (Updated 05/08/2018) Terms of Use (Updated 05/08/2018)