eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Critical Care

Hyperkalemia: Follow-up

Author: Michael J Verive, MD, Medical Director, Pediatric Intensive Care, Department of Pediatrics, St Mary's Hospital for Women and Children
Contributor Information and Disclosures

Updated: Jan 4, 2010

Follow-up

Further Inpatient Care

  • Hyperkalemia, by itself, is not a disease and is generally the result of diseases such as congenital adrenal hyperplasia, acute renal failure, rhabdomyolysis, or tumor lysis syndrome.
  • Following emergent management and stabilization of hyperkalemia, the patient should be hospitalized, and further workup should be initiated to determine the inciting cause and to prevent recurrence.

Further Outpatient Care

  • Continuing care relates to the basic disease process that led to the hyperkalemia.
  • In patients with salt-wasting congenital adrenal hyperplasia, corticosteroid and mineralocorticoid supplementation are necessary.
  • Continued renal replacement therapy may be needed for patients with acute renal failure.
  • Patients with chronic mineralocorticoid deficiency require mineralocorticoid supplementation (eg, fludrocortisone).

Transfer

  • Patients with acute life-threatening hyperkalemia should receive care in a pediatric or neonatal ICU capable of providing emergent hemodialysis.
  • Any child who develops hyperkalemia as a result of renal failure should be referred to a pediatric nephrologist for continuing care.

Complications

  • If untreated, severe hyperkalemia can result in cardiac arrhythmia or death.
  • Treatment of pseudohyperkalemia may result in hypokalemia; thus, treatment of non–life-threatening hyperkalemia should be deferred pending verification of hyperkalemia.
  • Failure to determine and treat the underlying disease process causing hyperkalemia can predispose patients to recurrent, life-threatening hyperkalemia.

Prognosis

  • Prognosis depends on the etiology.

Patient Education

  • Teach patients to recognize the symptoms of hyperkalemia, such as palpitations, dizziness, and weakness.

Miscellaneous

Medicolegal Pitfalls

  • Failure to obtain historical data that may lead to the diagnosis of hyperkalemia is a potential pitfall, as in the case of a previously healthy toddler who presents with hyperkalemia and arrhythmias after ingesting potassium tablets. Failure to suspect hyperkalemia may prevent the physician from eliciting historical information about medications at home. If the practitioner does not suspect hyperkalemia, no appropriate treatment can be administered.
  • With congenital adrenal hyperplasia, hyperkalemia is frequently observed with hyponatremia in an infant who presents with circulatory collapse. Failure to recognize this disease entity prevents the physician from administering corticosteroids, which are essential to appropriate treatment of these children.
  • Failure to recognize ECG patterns of hyperkalemia (eg, tall, peaked T waves; tall, peaked sine waves) also leads to inappropriate treatment. For example, a child with chronic renal failure or congenital adrenal hyperplasia may present with nonspecific symptoms of nausea and vomiting yet have an elevated serum potassium level. Failure to obtain an ECG or the inability to recognize the classic ECG signs of hyperkalemia prevents the physician from obtaining appropriate serum electrolyte measurements and, more importantly, prevents the physician from instituting appropriate life-saving measures.

Special Concerns

  • Patients with burns, crush injuries, and myopathies are at high risk of developing hyperkalemia, which is aggravated by the administration of succinylcholine. This drug should be avoided in such patients.
 


More on Hyperkalemia

Overview: Hyperkalemia
Differential Diagnoses & Workup: Hyperkalemia
Treatment & Medication: Hyperkalemia
Follow-up: Hyperkalemia
Multimedia: Hyperkalemia
References
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References

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Further Reading

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Keywords

hyperkaliemia, hyperpotassemia, potassium, potassium level, serum potassium level, K+, potassium excretion, potassium intake, hemolysis, phlebotomy, fictitious hyperkalemia, pseudohyperkalemia, true hyperkalemia, renal insufficiency, treatment, diagnosis, symptoms

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Contributor Information and Disclosures

Author

Michael J Verive, MD, Medical Director, Pediatric Intensive Care, Department of Pediatrics, St Mary's Hospital for Women and Children
Michael J Verive, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

G Patricia Cantwell, MD, Associate Clinical Professor, Department of Pediatrics, University of Miami; Director of Pediatric Critical Care Medicine, Miller School of Medicine, Jackson Children's Hospital
G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Barry J Evans, MD, Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center
Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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