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Differential Diagnosis: Hyperkalemia

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

Internal Medicine

|November 2019|Peer Reviewed

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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.


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

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