Pediatric Hyperkalemia Differential Diagnoses

Updated: Dec 30, 2019
  • Author: Michael J Verive, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
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Diagnostic Considerations

Important considerations

Clinicians should ensure they obtain historical data that may lead to the diagnosis of hyperkalemia, 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.

Differential Diagnoses