Hypokalemia and hyperkalemia: Two Sides of the Same Coin
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v31.i2.26112Keywords:
dyskalemia, hyperkalemia, hypokalemia, potassium disturbance, potassium homeostasis, renal physiologyAbstract
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.
Downloads
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.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Joana Tavares, Sara Mosca, Maria do Sameiro Faria, Conceição Mota
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.