Disease relevance of Hyperkalemia

• Hyporeninemic hypoaldosteronism is an important cause of hyperkalemia and is characterized by low renin secretion [1].
• Positional cloning implicated the serine-threonine kinase WNK4 in this process; clustered mutations in PRKWNK4, encoding WNK4, cause hypertension and hyperkalemia (pseudohypoaldosteronism type II, PHAII) by altering renal NaCl and K+ handling [2].
• Indomethacin-induced hyperkalemia in three patients with gouty arthritis [3].
• Reversible acute renal insufficiency and hyperkalemia following indomethacin therapy [4].
• To examine the precise role of potassium and aldosterone on acid-base composition and on collecting tubule ATPases, glucocorticoid-replete adrenalectomized rats were replaced with zero, physiological, or pharmacological doses of aldosterone and were fed varying potassium diets to produce hypokalemia, normokalemia, or hyperkalemia [5].

High impact information on Hyperkalemia

• This explains the hypertension of PHAII but does not account for the hyperkalemia [2].
• Hyperkalemia due to nafamostat mesylate [6].
• Brief report: trimethoprim-induced hyperkalemia in a patient with AIDS [7].
• Hyperkalemia during treatment with HMG-CoA reductase inhibitor [8].
• The defense against hyperkalemia: the roles of insulin and aldosterone [9].

Chemical compound and disease context of Hyperkalemia

• Fatal hyperkalemia from accidental overdose of potassium chloride [10].
• Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use [11].
• Hyperkalemia resulting from captopril administration [12].
• Digoxin intoxication and hyperkalemia [13].
• Diltiazem and hyperkalemia [14].

Biological context of Hyperkalemia

• Nhe3-/- mice maintained on a Na+-restricted diet for 3 days exhibited hyperkalemia, urinary salt wasting, acidosis, sharply reduced blood pressure and GFR, and evidence of hypovolemic shock [15].
• Heparin-induced hyperkalemia after cardiac surgery [16].
• Regulation of Na/K-ATPase gene expression by thyroid hormone and hyperkalemia in the heart [17].
• This effect, although minor (0.15 mEq/L above baseline), may cast some doubt on the role of salbutamol inhalation as the first treatment for excessive hyperkalemia [18].
• Missense mutations in the WNK4 gene have been postulated to cause pseudohypoaldosteronism type II, an autosomal-dominant disorder characterized by hyperkalemia and hypertension [19].

Anatomical context of Hyperkalemia

• The postulation of a defective cell membrane impeding potassium influx is supported by the failure of glucose and insulin infusions to substantially reduce hyperpotassemia [20].
• After acetazolamide administration, during extracellular fluid volume contraction or expansion or acute hyperkalemia, the TGF mechanism responds appropriately with regard to volume balance [21].
• We describe a 25-year-old man who was brought to the emergency department with skeletal muscle weakness, respiratory arrest, and rhabdomyolysis, as well as life-threatening hyperkalemia, after ingesting a depilatory containing barium sulfide (Magic Shave; Carson Products Co, Savannah, Ga) [22].
• As maternal hyperkalemia quickly induces fetal hyperkalemia, it was decided to investigate the effect of small elevations of plasma [K+] on the peripheral blood aldosterone concentration in chronically catheterized ovine fetuses and to compare this response to that obtained in the adult ewe both pregnant and nonpregnant [23].
• The influence of hyperkalemia on the central nervous system and cardiac toxicity of bupivacaine and lidocaine was studied in open-chested mechanically ventilated dogs [24].

Gene context of Hyperkalemia

• Intronic deletions with increased expression of a ubiquitous long WNK1 transcript cause pseudohypoaldosteronism type 2 (PHA II), characterized by hypertension and hyperkalemia [25].
• A rare form of monogenic hypertension is familial hyperkalemia and hypertension, which is caused by mutations in the kinases WNK1 or WNK4 and other unknown molecular defects [26].
• In summary, the gain of renal safety by use of preferential or specific COX-2 inhibitors is small or negligible with respect to sodium retention, hyperkalemia and probably water intoxication [27].
• Notable laboratory findings were hyperkalemia, high plasma renin, and low-normal aldosterone levels [28].
• The decreased surface expression of ROMK caused by mutant WNK4 was postulated to be a mechanism for decreased potassium secretion in distal nephrons that would presumably lead to hyperkalemia [19].

Analytical, diagnostic and therapeutic context of Hyperkalemia

• Nebulized albuterol for acute hyperkalemia in patients on hemodialysis [29].
• To evaluate the mechanism of cyclosporine-induced hyperkalemia, the renin-angiotensin-aldosterone system and renal potassium clearance were compared in ten renal transplant recipients treated with cyclosporine and treated with azathioprine [30].
• Three patients who were treated with ketorolac tromethamine (Toradol), an injectable nonsteroidal anti-inflammatory drug for pain management, developed acute renal failure or hyperkalemia or both [31].
• We used hemofiltration to treat a patient with digoxin overdose complicated by refractory hyperkalemia, congestive heart failure, chronic renal failure, and complete atrioventricular heart block [32].
• The modest (< or =0.2 mEq/liter at 200 mg/d) mean elevation in plasma [K+] suggests that titration to effect rather than forced titration may minimize the risk of hyperkalemia, even where relatively high (100-200 mg/d) doses of the specific mineralocorticoid receptor antagonist eplerenone may ultimately be required [33].

References