Hypokalemia and hyperkalemia: Two Sides of the Same Coin

Authors

  • Joana Tavares Pediatric Nephrology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto https://orcid.org/0000-0002-3776-4923
  • Sara Mosca Pediatric Nephrology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto https://orcid.org/0000-0002-5474-7236
  • Maria do Sameiro Faria Pediatric Nephrology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto https://orcid.org/0000-0002-8061-9289
  • Conceição Mota Pediatric Nephrology Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v31.i2.26112

Keywords:

dyskalemia, hyperkalemia, hypokalemia, potassium disturbance, potassium homeostasis, renal physiology

Abstract

Introduction: Potassium (K+) is the main intracellular cation and is crucial for normal cellular function, especially during children’s development and growth course. Changes in the homeostatic mechanisms of potassium regulation can lead to hypokalemia or hyperkalemia.
Objective: This study aimed to provide a narrative review of this common, yet complex, condition of the clinical practice.
Development/Conclusion: A comprehensive knowledge of the physiology of potassium metabolism is required to diagnose and treat its disturbances. Nearly 98% of potassium is intracellular, with the concentration gradient maintained by the sodium (Na+)/K+ ATPase pump located in the plasma membrane of cells. Several mechanisms, as β-adrenergic tone, insulin, and acid-base status, interfere with potassium intracellular distribution, but it is the kidney that has the key role in determining the total body potassium content, as it is responsible for approximately 80% of its excretion. The causes of hypokalemia are a mirror of hyperkalemia. Although these are two different entities, both require prompt intervention. The rate of correction depends on the severity of symptoms, presence of changes in electrocardiogram, and time of development of the disorder.

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References

Palmer BF. Regulation of Potassium Homeostasis. Clinical journal of the American Society of Nephrology : CJASN. 2015;10(6):1050-60.

Gumz ML, Rabinowitz L, Wingo CS. An Integrated View of Potassium Homeostasis. New England Journal of Medicine. 2015;373(1):60-72.

Bonilla-Félix M. Potassium regulation in the neonate. Pediatric nephrology (Berlin, Germany). 2017;32(11):2037-49.

Young DB, Jackson TE. Effects of aldosterone on potassium distribution. The American journal of physiology. 1982;243(5):R526-30.

Palmer BF, Clegg DJ. Physiology and Pathophysiology of Potassium Homeostasis: Core Curriculum 2019. American Journal of Kidney Diseases. 2019;74(5):682-95.

I. David Weiner SLL, Charles S. Wingo. Disorders of Potassium Metabolism. In: Elsevier, editor. Comprehensive Clinical Nephrology2019. p. 111-23.

DuBose TD, Jr. Regulation of Potassium Homeostasis in CKD. Advances in chronic kidney disease. 2017;24(5):305-14.

Han K-H. Mechanisms of the effects of acidosis and hypokalemia on renal ammonia metabolism. Electrolyte Blood Press. 2011;9(2):45-9.

Elisaf M, Siamopoulos KC. Fractional excretion of potassium in normal subjects and in patients with hypokalaemia. Postgrad Med J. 1995;71(834):211-2.

Choi MJ, Ziyadeh FN. The utility of the transtubular potassium gradient in the evaluation of hyperkalemia. Journal of the American Society of Nephrology : JASN. 2008;19(3):424-6.

Cummings BM, Macklin EA, Yager PH, Sharma A, Noviski N. Potassium abnormalities in a pediatric intensive care unit: frequency and severity. Journal of intensive care medicine. 2014;29(5):269-74.

Fuentebella J, Kerner JA. Refeeding syndrome. Pediatric clinics of North America. 2009;56(5):1201-10.

Fontaine B, Lapie P, Plassart E, Tabti N, Nicole S, Reboul J, et al. Periodic paralysis and voltage-gated ion channels. Kidney international. 1996;49(1):9-18.

Kung AW. Clinical review: Thyrotoxic periodic paralysis: a diagnostic challenge. The Journal of clinical endocrinology and metabolism. 2006;91(7):2490-5.

Knochel JP, Dotin LN, Hamburger RJ. Pathophysiology of intense physical conditioning in a hot climate. I. Mechanisms of potassium depletion. The Journal of clinical investigation. 1972;51(2):242-55.

Scurati-Manzoni E, Fossali EF, Agostoni C, Riva E, Simonetti GD, Zanolari-Calderari M, et al. Electrolyte abnormalities in cystic fibrosis: systematic review of the literature. Pediatric nephrology (Berlin, Germany). 2014;29(6):1015-23.

Michael J Somers AZT. Hypokalemia in children. In: Mattoo TK, editor. UpToDate Wolters Kluwer; 2020.

Batlle D, Haque SK. Genetic causes and mechanisms of distal renal tubular acidosis. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2012;27(10):3691-704.

Taketomo CK, Hodding JR, Kraus DM. Pediatric and neonatal dosage handbook. 28th ed: Wolters Kluwer; 2021.

Kunin AS, Surawicz B, Sims EA. Decrease in serum potassium concentrations and appearance of cardiac arrhythmias during infusion of potassium with glucose in potassium-depleted patients. The New England journal of medicine. 1962;266:228-33.

Schaefer TJ, Wolford RW. Disorders of potassium. Emergency medicine clinics of North America. 2005;23(3):723-47, viii-ix.

Somers MJ. Causes, clinical manifestations, diagnosis, and evaluation of hyperkalemia in children. In: Mattoo TK, editor. UpToDate: Wolters Kluwer; 2021.

Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatric nephrology (Berlin, Germany). 2011;26(3):377-84.

Bockenhauer D. Inherited Disorders of Sodium and Water Handling. In: Elsevier, editor. Comprehensive Clinical Nephrology2019. p. 575-85.e.1.

Ronco C, Bellomo R, Kellum JA, Ricci Z. Critical care nephrology e-book: Elsevier Health Sciences; 2017.

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Published

2022-06-30

How to Cite

1.
Tavares J, Mosca S, Faria M do S, Mota C. Hypokalemia and hyperkalemia: Two Sides of the Same Coin. REVNEC [Internet]. 2022Jun.30 [cited 2022Aug.12];31(2):137-4. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/26112

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