Nephrology Question 10 Instructor

A 74 year male was last noted to have a creatinine of 86 micromol/L 2 days prior to presentation. On presentation, his creatinine is 186 micromol/L and his potassium is 7.6 mmol/L.

Is this degree of hyperkalemia expected in this case of acute renal failure?

Name 4 conditions which may present with acute renal failure and severe hyperkalemia (higher than generally expected in acute renal failure). Hint: think of intracellular sources of potassium.

When patients develop acute renal failure, they often have a suddenly reduced capacity to excrete potassium and other solutes via the kidney. However, it generally takes time for potassium levels to rise as ongoing potassium intake overwhelms excretory capacity. When one sees a sudden and significant rise in potassium very soon after the onset of acute renal failure, one should consider the possibility of a unifying explanation for acute renal failure and a large potassium load.

This can be seen in conditions such as:

  • Hemolysis
  • Rhabdomyolysis
  • GI bleed
  • Tumor lysis syndrome

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