Miakinkova L. O., Toronchenko O. M.

LITERATURE REVIEWS

Scentific article

Hyperkalemia is an electrolyte disorder with potentially life-threatening consequences such as fatal arrhythmias. The main causes of hyperkalemia are conditions that lead to a decrease in potassium excretion and conditions that promote the movement of intracellular potassium into the extracellular space. Separately, iatrogenic hyperkalemia and pseudohyperkalemia should be distinguished. Hyperkalemia is particularly common in metabolic acidosis, insulin deficiency, hyperglycemia, hyperosmolar states. Medicines such as inhibitors of the renin-angiotensin-aldosterone system can increase potassium levels. Therefore, the establishment of the etiological factor is the first step in the examination of a patient with suspected hyperkalemia. Knowledge of the physiological mechanisms of potassium homeostasis is important for understanding the causes and complications of hyperkalemia. Potassium is predominantly an intracellular cation and plays a significant role in the formation of the membrane potential of cell rest. Violation of the transmembrane potassium gradient has a negative effect on the functioning of mainly the cardiovascular and nervous systems. ECG changes are important diagnostic criteria for suspected hyperkalemia. Therefore, in the review, with particular attention, electrophysiological and electrocardiographic changes with an increase in potassium levels, presented by an ECG from our own experience, are discussed. Clinical signs of elevated potassium levels are nonspecific and are predominantly associated with muscle or cardiac dysfunction. Despite various recommendations, there is no generally accepted consensus on the algorithm for the management of patients with hyperkalemia and precise thresholds for potassium concentration. Urgent correction of hyperkalemia is indicated in the presence of ECG changes, severe acidosis, a rapid increase in serum potassium levels and a decrease in renal function. The paper provides an overview of modern views and recommendations for the diagnosis and treatment of hyperkalemia, as well as highlights a number of topical issues that remain unresolved at the present time.

hyperkalemia, homeostasis, mechanisms of regulation, ECG diagnostics, emergency care, treatment.

1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. DOI: 10.1093/eurheartj/ ehab368.
2. Alfonzo A, Harrison A, Baines R, Chu A, Mann S, MacRury M. Treatment of Acute Hyperkalaemia in adults. Renal Association Clinical Practice Guidelines; 2020. 161 р. Available from: https://renal.org/sites/renal. org/files/RENAL%20ASSOCIATION%20HYPERKALAEMIA%20GUIDELINE%202020.pdf
3. Miakinkova LO, Baklytskyi DD. Vypadok krytychnoi hiperkaliiemii pid maskoiu hostroho koronarnoho syndromu. Ukrainskyi kardiolohichnyi zhurnal. 2020;27(2):43. [in Ukrainian].
4. Toronchenko OM, Miakinkova LO, Baklytskyi DD. Pomylky pid chas nadannia ekstrenoi medychnoi dopomohy patsiientam z EKHoznakamy hostroho koronarnoho syndromu na tli dekompensatsii tsukrovoho diabetu z hiperkaliiemiieiu. Patolohiia. 2021;18(2):243-250. DOI: https://doi.org/10. 14739/2310-1237.2021.2.225044. [in Ukrainian].
5. Palmer BF, Carrero JJ, Clegg DJ, Colbert GB, Emmett M, Fishbane S, et al. Clinical Management of Hyperkalemia. Mayo Clinic Proceedings. 2021;96(3):744-762. DOI: https://doi.org/10.1016/j.mayocp.2020.06.014.
6. Raebel M. Hyperkalemia Associated with Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers. Cardiovascular Therapeutics. 2012;30(3):e156-e166. DOI: https://doi.org/10.1111/j.1755-5922.2010.00258.x.
7. Meng QH, Wagar EA. Pseudohyperkalemia: a new twist on an old phenomenon. Critical reviews in clinical laboratory sciences. 2015;52(92):45-55. DOI: https://doi.org/10.3109/10408363.2014.966898/.
8. Hollander-Rodriguez JC, Calvert JF Jr. Hyperkalemia. Am Fam Physician. 2006 Jan 15;73(2):283-90.
9. Dudar I. Hiperkaliiemiia v klinichnii praktytsi. Indyvidualizatsiia korektsii hiperkaliiemii: tochka zoru nefroloha. Medychna hazeta Zdorovia Ukrainy. 2018;1(12):26-29. Dostupno: https://health-ua.com/article/37150-gperkal mya-vklnchnj-praktitc-ndivdualzatcya-korektcgperkalm-tochka-zoru-ne. [in Ukrainian].
10. Kayukov IG, Smirnov AV, SHabunin MA, Esayan AM, Kucher AG, Ryss ES, et al. Redkie zabolevaniya v praktike vzroslogo nefrologa: sostoyaniya, associirovannye s gipokaliemiej. Soobshchenie I. gomeostaz kaliya, klassifikaciya i klinika gipokaliemij. Nefrologiya. 2008;12(4):81-92. [in Russian].
11. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et. al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-177. DOI: 10.1093/eurheartj/ehx393.
12. Weiss JN, Qu Z, Shivkumar K. Electrophysiology of Hypokalemia and Hyperkalemia. Circulation: Arrhythmia and Electrophysiology. 2017;10(3):e004667. DOI: doi.org/10.1161/CIRCEP.116.004667.
13. Parham WA, Mehdirad AA, Biermann KM, Fredman CS. Hyperkalemia revisited. Tex Heart Inst J. 2006;33(1):40-7.
14. Navchalʹni materialy onlayn. Medytsyna Dostupno: https://pidru4niki.com/80747/meditsina/potentsial_tipovih_klitin_miokarda_fazi. [in Ukrainian].
15. Simon L, Hashmi M, Farrell M. Hyperkalemia [Internet]. 2021. Available from: .
16. Li T, Vijayan A. Insulin for the treatment of hyperkalemia: a double-edged sword? Clinical Kidney Journal. 2014;7(3):239-241. DOI: doi. org/10. 1093/ckj/sfu049.
17. Derzhavnyi formuliar likarskykh zasobiv. Amiodaron (Amiodarone) [Internet]. Kyiv: Derzhavnyi formuliar likarskykh zasobiv; Dostupno: http://preparaty.org/info/126. [in Ukrainian].
18. Kristensen SL, Docherty KF, Jhund PS, Bengtsson O, Demets DL, Inzucchi SE, et al. Dapagliflozin reduces the risk of hyperkalaemia in patients with heart failure and reduced ejection fraction: a secondary analysis DAPA- HF. European Heart Journal. 2020;41(2):939-946. DOI: https://doi.org/10. 1093/ehjci/ehaa946.0939.
19. Voronkov LH, Amosova KM, Dziak HV, Zharinov OI, Kovalenko VM, Korkushko OV, et al. Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti. Kyiv; 2017. 68 s. [in Ukrainian].
20. Rosano GMC, Tamargo J, Kjeldsen KP, Lainscak М, Agewa S, Anker SD, et al. Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother. 2018;4(3):180-188. DOI: 10.1093/ehjcvp/pvy015.
21. Derzhavnyi Ekspertnyi Tsentr MOZ Ukrainy. Inspra (eplerenon) [Internet]. Kyyiv: Derzhav Ekspertnyi Tsentr MOZ Ukrainy; 2015 Ber 25. Dostupno: https://www.dec.gov.ua/materials/inspra-eplerenon/. [in Ukrainian].
22. Rafique Z, Chouihed T, Mebazaa A, Peacock WF. Current treatment and unmet needs of hyperkalaemia in the emergency department. European Heart Journal Supplements. 2019;21(А):12-19. DOI: https://doi.org/10. 1093/eurheartj/suy029.
23. Colbert GB, Patel D, Lerma EV. Patiromer for the treatment of hyperkalemia. Expert Review of Clinical Pharmacology. 2020;13(6):563-570. DOI: 10.1080/17512433.2020.1774363.

«Bulletin of problems biology and medicine» Issue 4 (162), 2021 year, 47-54 pages, index UDK 616.12-008.1-071

10.29254/2077-4214-2021-4-162-47-54