Acidosis and Potassium Balance

Clinical Implications

In primary adrenal insufficiency, hyperkalaemia is present in approximately half of patients at diagnosis due to aldosterone deficiency, impaired glomerular filtration, and acidosis 1, 2
During treatment of diabetic ketoacidosis, correction of acidosis and volume expansion decrease serum potassium concentration, and to prevent hypokalemia, potassium replacement should be initiated after serum levels fall below 5.5 mEq/l, assuming adequate urine output 3

In preterm infants, non-oliguric hyperkalemia can develop after birth even without potassium intake, and risk factors include lack of antenatal corticosteroids, systemic acidosis, birth asphyxia, and catabolic states 4

Treatment of hyperkalemia should be based on the underlying cause 6
In patients with cardiovascular disease and chronic kidney disease, up to 50% of hyperkalemia cases recur within one year, and life-threatening hyperkalemia requires immediate treatment with calcium carbonate, insulin with or without glucose, and/or beta-adrenergic agonists to shift potassium into cells 7